Setting

This audit is of most relevance to assertive outreach teams, where many patients are on long-term antipsychotic medication. It may also be relevant in forensic mental health settings and first-episode psychosis services.

Background

The metabolic syndrome comprises a cluster of features: hypertension, central obesity, glucose intolerance/insulin resistance and dyslipidaemia. These features are predictive of both type II diabetes and cardiovascular disease. There is increasing concern that antipsychotic medications, particularly atypical drugs, contribute to the risk of metabolic syndrome (Allison et al, 1999; Taylor & McAskill, 2000).

Standards

The following standards were obtained from the Prescribing Observatory of Mental Health (POMH) (Barnes et al, 2008). All patients prescribed or continuing antipsychotic medication should have the following parameters measured at least once a year:

ᐅ blood pressure

ᐅ body mass index (or other measure of obesity)

ᐅ blood glucose (or HbA1c)

ᐅ lipid profile.

Method

Data collection

Demographic and clinical variables and metabolic side-effect screening data were collected from case notes. The following were recorded for each patient:

ᐅ age, gender, ethnicity and diagnostic grouping

ᐅ the names of all regular and as required (p.r.n.) antipsychotic drugs currently prescribed and whether or not the total dose exceeds the recommended daily maximum according to the British National Formulary (Joint Formulary Committee, 2009)

ᐅ the names of drugs other than antipsychotics currently prescribed

ᐅ evidence of screening for hypertension, obesity, raised blood glucose (or HbA1c) level and dyslipidaemia

ᐅ evidence of a known diagnosis of diabetes, hypertension or abnormal lipid profile

ᐅ whether risk factors were picked up through mental health screening.

Data analysis

The data were analysed at three levels: national, trust and assertive outreach team.

Resources required

People

This audit required at least one person from each team involved.

Time

Data collection took around 30 minutes per case, but depended on the extent of the case notes.

Results

In the baseline audit, 6% of the total national sample had a documented diagnosis of diabetes, hypertension and dyslipidaemia. Re-audit of case notes found each of the above parameters had increased to 7%. Screening for the metabolic syndrome in people prescribed antipsychotic medication increased considerably over the year of the project.