Setting

This audit is of relevance to all in-patient and out-patient settings. It was originally conducted in an in-patient child and adolescent intellectual disability setting.

Background

Antipsychotics are widely used for severe psychiatric disorders and for managing aggressive behaviours and anxiety related to autism. First-generation antipsychotics, while considered effective, are associated with serious acute and chronic side-effects that frequently limit their use. Second-generation antipsychotics are considered to be equally effective and are sometimes better tolerated. However, these newer antipsychotics are associated with metabolic side-effects, such as weight gain, hyperglycaemia, new-onset diabetes and dyslipidaemia. As these metabolic side-effects are so closely associated with the development of cardiovascular disease, monitoring and early intervention are crucial.

Standards

Standards were taken from the Maudsley guidelines (Taylor et al, 2007), which advise on recommended monitoring requirements for second-generation antipsychotic medication at baseline and follow-up:

ᐅ Baseline assessment should include full-blood count, and determination of HbA1c, urea and electrolytes, fasting lipid and fasting glucose levels, liver function tests, weight and blood pressure.

ᐅ Specific drugs require additional baseline tests:

ᐅ Assessment after 6–12 months should include full blood count, and determination of HbA1c, urea and electrolytes, fasting lipid and fasting glucose levels, liver function tests, weight and blood pressure.

ᐅ Specific drugs require additional follow-up tests:

Method

Data collection

ᐅ An audit tool facilitated data collection. It was designed for easy recording of the name of antipsychotic used, date prescribed, and whether general and specific baseline and follow-up standards had been met.

ᐅ Data were collected from the medical notes and drug charts of patients.

Data analysis

The percentage of patients who had met each of the standards was calculated.