Setting

This audit is relevant to all areas of psychiatry where physical aspects of health are monitored. It is of most relevance to in-patient units and day hospitals, where physical monitoring is performed regularly.

Background

Physical examination and physical health monitoring are essential to all patients in psychiatry. Guidance from both the National Institute for Health and Clinical Excellence (NICE) (2006, 2007) and the Royal College of Psychiatrists (2009) emphasises the need for physical examination of mental health service users. A range of equipment is required for clinicians to comply with these recommendations.

Standards

Standards were obtained from Physical Health in Mental Health: Final Report of a Scoping Group (Royal College of Psychiatrists, 2009). Standards are that the items listed below should be both present in treatment rooms and in working order:

ᐅ alcometer

ᐅ auroscope

ᐅ disposable gloves

ᐅ examination couch

ᐅ height measure

ᐅ neurological testing pins

ᐅ ophthalmoscope

ᐅ pulse oximeter

ᐅ Snellen chart

ᐅ sphygmomanometer

ᐅ stethoscope

ᐅ tendon hammer

ᐅ thermometer

ᐅ tuning fork (256 Hz)

ᐅ urinalysis kit

ᐅ videocamera (intellectual disability units only)

ᐅ weighing scales.

The target was that these standards were met for all treatment rooms.

Method

Data collection

Data were collected using a pro forma that covered the items listed above. One pro forma was completed for each area (e.g. a ward treatment room).

Data analysis

The percentage of equipment present in each treatment rooms and in working order was then calculated.

Resources required

People

This audit was completed by two people.

Time

Fifteen minutes was required to audit each treatment room.

Results

None of the areas assessed reached the 100% target set by the Royal College of Psychiatrists’ guideline. The following pieces of equipment were often not present or not in working order:

ᐅ auroscope

ᐅ neurological testing pins

ᐅ ophthalmoscope

ᐅ pulse oximeter

ᐅ tuning folk

ᐅ Snellen chart.

Recommendations

ᐅ An identified lead should be chosen on each ward to ensure medical equipment is present and functioning.

ᐅ A specific trolley containing essential blood-taking and physical examination equipment should be stored in each treatment room.

ᐅ A functional auroscope and ophthalmoscope should be available and kept in a specific secure location.