This audit was conducted in an in-patient intellectual disability service but is relevant to all psychiatrists working with in-patients.
A comprehensive, systematic investigation of physical health is a core component of the psychiatric assessment. If a patient's stay at an assessment and treatment facility becomes prolonged, it is essential that psychiatrists recognise the need for active health promotion, including formal health checks. This is particularly important in the continuing healthcare setting, where psychiatric services, in effect, assume the role normally carried out by the primary care team.
Standards were obtained from the Royal College of Psychiatrists’ 2009 report Physical Health in Mental Health. Of particular relevance were:
ᐅ physical examination of the patient within 24 hours of admission should be recorded in the patient's medical record (where this cannot be done, there should be a clear entry in the notes with an appropriate explanation)
ᐅ a record of health promotion/screening (e.g. smoking cessation) should be in the patient's notes
ᐅ medical history should be obtained within 1 week and made available in the patient's notes
ᐅ for those with epilepsy, a record of information concerning seizure type, frequency and rescue medication should be obtained within 1 week of admission and made available in the patient's notes
ᐅ weight and blood pressure should be recorded monthly.
Information pertaining to all of the above standards should be documented in the patients’ medical records. An anonymous pro forma was designed, with a simple checklist corresponding to the above standards.
The proportion of patient records in compliance with the standards was calculated.
This audit was undertaken by one person. For more than 25 patients, it is advisable that at least two people are involved. It is suitable for multidisciplinary involvement.
Approximately 30 minutes per set of case notes was required. The time taken will depend on the quality of note-keeping and ease of finding the information.
ᐅ Most patients received a physical examination by a doctor within 24 hours of admission. However, when this was not possible (perhaps because of the patient's extreme agitation), the reason was not adequately documented.
ᐅ For patients with epilepsy, there was reasonable recording in the notes of seizure type and frequency, but not of rescue medication.
ᐅ The recording of weight was erratic.