This audit is relevant to all psychiatrists but especially to out-patient settings. It was originally done in a service for early intervention in psychosis, but it is applicable to community mental health teams as well.
People with schizophrenia and bipolar disorder have a high rate of physical health problems. The guideline on schizophrenia produced by the National Institute for Health and Clinical Excellence (NICE) (2009) recommends regular monitoring of the physical health of patients (and a similar recommendation is made in the NICE guideline on bipolar disorder – National Institute for Health and Clinical Excellence, 2006).
NICE recommends the following:
ᐅ General practitioners and other primary healthcare professionals should monitor the physical health of people with schizophrenia at least once a year.
ᐅ A copy of the results should be sent to the care coordinator and/or psychiatrist, and filed in the secondary care notes.
ᐅ As part of the care programme approach (CPA), healthcare professionals in secondary care should ensure that the regular physical health checks are being carried out in primary care.
According to the Maudsley prescribing guidelines (Taylor et al, 2007), patients on psychotropic medications need regular monitoring of various parameters, depending upon the individual psychotropic agent, including:
ᐅ blood pressure
ᐅ blood sugar and lipid levels
ᐅ electrocardiogram (ECG)
ᐅ full blood count, urea and serum electrolytes, liver function tests and prolactin levels.
On the basis of the above recommendations, the following standards were set:
ᐅ All patients should have undergone at least one physical health check in the previous year.
ᐅ All patients should have a record of the results of a physical health check in their notes.
ᐅ An up-to-date report on all relevant physical health parameters should be available.
The medical notes of all the patients were examined for the following:
ᐅ documentation of a physical health check in the previous year
ᐅ documentation of measured physical health parameters.
The percentage of patients for whom following standards were met was calculated:
ᐅ at least one physical health check in the previous year
ᐅ a record of the results of the physical health check in the notes
ᐅ documentation of measurement of each individual physical health parameter.