Setting
The audit is specific to the specialty of perinatal psychiatry yet is relevant to all psychiatrists, as well as midwives and primary care professionals. It relates to out-patients.
Background
The National Institute for Health and Clinical Excellence (NICE) has produced guidelines on the prediction, detection and management of mental illness among pregnant women (including but not exclusively concerning those with established mental illness) and also the criteria for referral to perinatal psychiatric services.
Standards
The following standards come from the NICE guidelines Antenatal and Postnatal Mental Health (National Institute for Health and Clinical Excellence, 2007):
ᐅ Healthcare professionals should ensure that adequate systems are in place to ensure continuity of care and effective transfer of information, to reduce the need for multiple assessments.
ᐅ At a woman's first contact with services in both the antenatal and the postnatal periods, healthcare professionals (including midwives, obstetricians, health visitors and general practitioners) should ask about:
▹ past or present severe mental illness, including schizophrenia and bipolar disorder
▹ psychosis in the postnatal period and severe depression
▹ previous treatment by a psychiatrist or specialist mental health team, including in-patient care
▹ a family history of perinatal mental illness.
ᐅ If the woman has, or is suspected of having, a severe mental illness, she should be referred to a specialist mental health service.
Method
Data collection
Data were collected from referral letters or referral forms received by the perinatal service. The referral letter and forms were examined to see if the following information was present.
ᐅ information regarding the reason for referral, e.g. reasons for suspecting a mental illness
ᐅ details of past psychiatric history
ᐅ current risk factors for mental illness.
Data analysis
The percentages of referrals that met each of the three standards mentioned above were calculated.
Resources required
People
It is recommended that two or three people conduct the audit, which is suitable for multidisciplinary involvement.
Time
Around 3–4 weeks should be allowed for data collection and analysis.
Results
The frequencies with which the different types of information were recorded in the referral letters and forms are given in the table below, for both an initial and a re-audit performed 1 year later.
