Setting

This audit may be relevant to psychiatrists working in acute adult mental health in-patient settings.

Background

A third of the general population has used or is using illicit drugs, but the proportion is higher among ‘vulnerable groups’ (Health and Social Care Information Centre, 2007). People with mental illness are one such ‘vulnerable group’. Screening for drug use among psychiatric patients is safe, easy and effective. It can aid diagnosis and management and help with prognosis of symptoms or stability of mental health. The key issue is to recognise that substance misuse may be contributing to psychiatric problems and that, pragmatically, the two problems may have to be treated concurrently (Lingford- Hughes et al, 2004).

Standards

The recommendations produced by the British Association for Psychopharmacology (Lingford-Hughes et al, 2004) set the standards for this audit. Of particular relevance were:

ᐅ The assessment of the psychiatric patient in an in-patient facility must cover substance-induced and substance-related disorders.

ᐅ In order to help distinguish between severities of substance misuse disorders, a complete substance misuse history should be obtained, together with urine analysis and blood tests if possible.

Method

Data collection

Hospital managers and/or ward clerks hold lists of patient admissions. Clinical notes were obtained for all patients admitted within a defined period. Patient records were searched for documentation of drug history, and documentation of relevant investigations for drug screening.

Data analysis

The number of patients admitted to an in-patient unit with a possible diagnosis of substance-induced and/or substance-related disorder was noted. The percentages of patients who had a drug history taken on admission and who had urine analysis results documented were calculated.

Resources required

People

One person was required to review both the admission notes and the laboratory results.

Time

Collecting data took approximately 5 minutes per patient.

Results

More than half the new admissions did not have an adequate drug history documented. This improved with staff education and discussion. The number of urine drug screens performed was extremely low, but this improved on re-audit following awareness training.

Recommendations

ᐅ Medical staff should be educated about the need to take comprehensive drug histories and about the value of urine drug screening.

ᐅ A checklist should be included on the physical examination admission document to indicate whether urine testing is appropriate, and whether consent has been achieved.