Improving Cardiac Monitoring for Patients on Depot Antipsychotic Medication in a Mental Health Service for Homeless People

AIMS: Patients under the Joint Homelessness Team (JHT) in Westminster have poor health outcomes as they face the double-hit of serious mental health illness (SMI) and homelessness. Many patients are on depot antipsychotic medication to manage their SMI. Depot antipsychotics are associated with increased risk of arrythmias and guidance advises annual electrocardiogram (ECG) monitoring for all (Maudsley: Prescribing Guidelines in Psychiatry, Taylor). However, a proportion of JHT patients are not well engaged with services and do not have an annual ECG recorded on SystmOne. In this QI study, we aimed to improve the percentage of JHT patients on depot antipsychotic medication who have a recorded ECG within the year on SystmOne, from current level to 80% over a 4-month period. METHODS: 44 patients at JHT were identified as being on depot antipsychotic medication (1 patient was later excluded due to ongoing inpatient admission). PDSA cycles were used over a 4-month period from October 2022 to January 2023. Intervention 1: Using available ECGs from GP or secondary care records to update SystmOne records. Intervention 2: Email to GP requesting they invite patients for annual ECG. Intervention 3: JHT inviting patients for targeted ECGs. RESULTS: At baseline only 48.8% of patients had an ECG recorded on SystmOne within the last year. Intervention 1 increased our recorded ECGs to 72.1%. Intervention 2 increased completed ECGs to 74%. Finally, intervention 3 increased completed ECGs to 83.7% by Mid-January 2023. Overall, results show an improvement of 34.9% or relative increase of 1.71 times the amount of recorded ECG over 4 months. CONCLUSION: As a result of incorporating dedicated liaison and clinical time, we have improved uptake of annual ECG monitoring of patients on depot antipsychotic medication. We found there was a lot of existing physical health data in the GP and secondary care records that was not readily accessible to JHT. In the future, with the development of shared clinical data systems, both primary and secondary care teams may be able to save time and resources by avoiding duplication of data. There remains room for improvement with 16.3% of patients still without an annual ECG. This is due to accessibility and engagement difficulties for people with SMI & history of homelessness. We propose further intervention with a portable ECG machine to improve engagement with these remaining patients. This project is being used as a business proposal to secure funding for a portable ECG device currently.