Setting

This audit is relevant to any psychiatrist who prescribes depot antipsychotics; in general adult and forensic services it will apply to a large number of patients. It can apply to in-patients as well as out-patients.

Background

The Prescribing Observatory for Mental Health (POMH-UK) runs national audit-based quality improvement programmes open to all specialist mental health services in the UK. The aim is to help mental health services to improve prescribing practice in discrete areas. This audit addresses the quality of assessment of side-effects in patients prescribed depot or long-acting injections of antipsychotics. The decision was taken to limit the audit sample to patients prescribed depot antipsychotic medication because such patients have regular contact with health professionals when they receive their injection, which should provide an opportunity for routine monitoring of side-effects.

Standards

The National Institute for Health and Clinical Excellence (NICE) (2009) provides the following standards:

ᐅ Antipsychotic side-effects should be monitored routinely and regularly.

ᐅ People receiving depot preparations should be maintained under regular clinical review, particularly in relation to the risks and benefits of the medication.

From the above targets POMH derived a minimum standard of review of sideeffects once a year for all patients prescribed depot or long-acting injection antipsychotics. It was expected that this would be achieved for 100% of patients.

Method

Data collection

All patients prescribed depot or long-acting injection antipsychotics were identified using prescribing data from the pharmacy department. The medical records of the identified patients were examined to determine compliance with the standard of documented annual review of side-effects.

Data analysis

ᐅ Basic demographic data were collected to aid understanding of the audit data, for example:

ᐅ In addition to determining whether there was documentation relating to any sideeffects it was useful specifically to consider whether there was a record of:

ᐅ If patients were experiencing side-effects, it should be noted whether appropriate action was taken (e.g. blood test for prolactin level, consideration of medication for extrapyramidal side-effects).

ᐅ The percentage of patients with an enquiry relating to side-effects was calculated.