Monitoring of Physical Health in Patients Prescribed Antipsychotic Medication Within a Medium-Secure Forensic Inpatient Setting: Assessing Compliance With Guidelines and Improving Procedures

AIMS: Antipsychotic use is associated with haematological, metabolic and cardiovascular abnormalities. If not monitored and acted upon, these contribute to the increased burden of physical health problems in those with severe mental illness. Appropriate monitoring (including blood tests and ECGs) is required in accordance with NICE guidelines. The aim of our project was to assess our adherence (within a medium-secure forensic inpatient setting) to guidelines, and to improve procedures and processes within the unit. The majority of our patients are taking antipsychotic medication, but prior to our project there was no system in place to determine who was due which monitoring tests and when. Our suspicion was that patients’ physical health was not being adequately monitored especially given the unit's lack of input from general practitioners. METHODS: Our initial audit of patient notes took place in October 2022, assessing whether each of our 35 patients had had appropriate ECG and blood monitoring. After gathering these initial data we then systematically offered patients their monitoring. We set up processes to ensure this would be completed in a timely and organised fashion in the future, via creating a spreadsheet available on the shared drive and a chart within the doctor's office, adding instructions to the departmental junior doctor handbook, and liaising with colleagues. RESULTS: Of 35 patients, 34 (97%) were prescribed antipsychotics, 18 (51%) of these at ‘high dose’. Of those 34, blood tests for 22 (65%) patients were out of date or not completed as per NICE guidelines. ECGs for 21 (62%) patients were either missing or out of date. Following our gathering of the initial data and systematic completion of patient monitoring, at the time of re-audit in January 2023 monitoring was either completed or offered (with patient refusal) for 34 (100%) of patients. CONCLUSION: We identified that monitoring of physical health in those prescribed antipsychotics within our unit was sub-par, with the majority of patients not up to date with bloods or ECGs as per NICE guidelines when initial data were collected in October 2022. Following our project, at the time of re-audit in January 2023 monitoring was either completed or offered to 100% of patients. We have implemented systems to ensure this continues in the future, beyond junior doctor changeovers. This has potential application to other longer-stay psychiatric wards such as general adult rehabilitation wards and other forensic units.