Setting

This audit is relevant to all psychiatric specialties. It is of particular relevance to junior members of staff, who complete the majority of admission histories and physical examinations.

Background

People with mental health needs are at increased risk of physical illness, morbidity and mortality compared with the general population (Garden, 2005). Many medications used in psychiatry contribute to illness, compounding poor lifestyle choices and socioeconomic difficulties. Admission to hospital provides an opportunity to assess a patient's health status and to start treatment or refer to other specialties if appropriate.

Standards

Standards were obtained from the Worcestershire Mental Health Partnership NHS Trust (2003) guideline on physical health for in-patients. Mental health trusts should have auditable physical health standards. The Worcestershire standards are in line with guidance from the Royal College of Psychiatrists (2009), which also has auditable standards. Of particular relevance are the following standards:

ᐅ All patients should have a physical examination within 24 hours of admission. If the patient is confused, the examination should be conducted immediately. If the examination is delayed, a valid reason should be documented.

ᐅ A medical history should be present in the notes, covering past and present illness, family history of physical health and current medication.

ᐅ A comprehensive physical examination should be performed, including cardiovascular, gastrointestinal, respiratory, genitourinary, neurological and dental assessment, plus height, weight and waist measurements.

ᐅ The history should include an assessment of risk factors contributing to physical illness, including alcohol and illicit substance use, exercise, diet and sexual health. Physical health screening should be noted.

ᐅ Clinical investigations should include: urine drug screen, urea and electrolytes, liver function test, full blood count, glucose, thyroid function test and other hormones if required. Documentation of consideration of other investigations, for example radiography, computerised tomography, bone scans and electrocardiography should be made.

Method

Data collection

A sample of 30 case notes from a range of wards was selected to audit over a specified time frame.