An Audit Looking at the Monitoring for Long-Term Antipsychotic Use on an Adult Inpatient Psychiatry Ward

AIMS: Patients with psychiatric disorders have been well documented to have an increased risk of cardiovascular disease and consequently a higher incidence of premature mortality. Literature has shown that many psychiatric disorders, particularly major depressive disorder, bipolar affective disorder, attention deficit hyperactivity disorder, post-traumatic stress disorder, anxiety disorders, and schizophrenia have an increased risk of metabolic syndrome. This increased prevalence of metabolic syndrome, and as a result cardiovascular disease, has been linked to factors that clinicians are involved in, such as the prescription of antipsychotic medication. it is therefore important for clinicians to be able to appropriately monitor patients on antipsychotic medications. Aim: To improve the physical health aspects of care for patients with psychiatric illnesses admitted as inpatients. 1. To ensure appropriate monitoring of the metabolic parameters of patients on admission. 2. To ensure appropriate ongoing monitoring of the metabolic parameters of patients during their hospital stay. METHODS: Data were collected independently by two people. The data were collected using PARIS, an online documentation program used by the Greater Manchester Mental Health (GMMH) trust, as well as the patients’ paper prescribing charts. A total of 20 patients were audited. Standards were set according to NICE guidelines on patients on long-term antipsychotics admitted to adult inpatient wards. A total of 14 standards were set. The areas audited were measurements of BMI, ECG, blood pressure, lipids, prolactin and urea and electrolytes at baseline, at prescribed time points, and at dose changes as required by guidance. RESULTS: Overall, five of the standards were attained, seven of the standards were not attained, one standard could only be partially analysed, and one standard (monitoring at 12 months) could not be analysed due inadequate patient length of stay CONCLUSION: 1. Consideration of a comprehensive admission proforma to help standardise the admissions process. 2. The development of a tool to remind clinicians to recheck metabolic parameters for ongoing monitoring at 3 months, 6 months, and 12 months. 3. Regular maintenance of the ECG machines to ensure no omissions in monitoring.