Audit and Re-Audit: Improving Standardised Admission Blood Tests Adherence for Psychiatric Intensive Care Unit (PICU) Patients

AIMS: 1. To evaluate current adherence with the Royal College of Psychiatrists guidance “Standards for Inpatient Mental Health Services”: Were the blood tests carried out within 24-hours of admission? 2. We standardised the blood test parameters that are required following admission to our PICU ward and measured if all relevant blood tests* were completed during admission. 3. Re-audit after implementation of a standardised policy.*(Full blood count, urea and electrolytes, liver function tests and lipid profile, CRP, thyroid function tests, vitamin B12, folate, prolactin, vitamin D, calcium and HbA1c%). METHODS: First cycle is an audit of electronic patient records for all admissions to the PICU ward in a two-month period by using an audit proforma to capture information to answer the questions above. After implementing a standardised guideline for PICU, second cycle was conducted over a two-month period for the re-audit. RESULTS: In the first cycle, a total of 20 patient records were audited. 30% had bloods taken within 24 hours of admission to PICU. 10% of patients had bloods taken on their previous ward. 40% of patients declined/unsafe, and 20% were not done in the timeframe. 69% of patients directly admitted to PICU had all the relevant admission blood tests completed and 23% had some of the blood tests done. These numbers were lower for the patients transferred to PICU from other wards. In the second cycle, a total of 16 patient records were audited. There was an improvement in number of patients having bloods done within 24 hours of admission with only 6% not done in the timeframe. Of the patients directly admitted to PICU, all the consenting patients (89%) had all the standardised blood tests. These figures remained lower for those patients transferred from other wards without an indication to retest the bloods. CONCLUSION: The standardised guideline for PICU that was implemented after the first cycle consisted of a pre-filled blood test request form which included all relevant parameters detailed above. This had a positive impact with a significant percentage increase in the total number of patients directly admitted to PICU having all relevant admission blood tests completed at re-audit (77% to 100%). There was also a significant percentage increase (80% to 94%) of bloods taken within 24 hours of admission to PICU. The next step will be to implement these pre-filled forms across all wards in the KMPT trust.