Assessement of Antipsychotic Side-Effects Monitoring in Learning Disability Patients in a Medium Secure Hospital

AIMS: Learning Disability population has increased neuroleptic sensitivity which predisposes to development of side-effects at even lower doses of antipsychotics. STOMP practices (Stopping OverMedication of People with a learning disability, autism or both psychotropic medications) advocate regular review of psychotropic medications, providing information about non-pharmacological therapy and involvement of patients and families about medications. Our audit aimed to understand how the side-effects in the Learning Disability patients who are on antipsychotics in a Medium Secure Hospital were being monitored in a 12-month period. The objectives were to assess whether the side-effects were being monitored regularly, whether a scale (Liverpool University Neuroleptic Side-Effect Rating Scale or LUNSERS) was being used or not, the grade of staff conducting the assessment and whether the outcomes being scored and reviewed adequately in Multi-Disciplinary Team meetings or Care Programme Approach meetings. METHODS: It was a retrospective, cross-sectional audit involving inpatients on the Learning Disability Wards of Rowan View (Medium Secure Hospital under Merseycare) in the time period 01/06/21 to 31/05/22. No patients were excluded. Data pertaining to assessment of side-effects to antipsychotics were collected from electronic database PACIS, the computer database used in Rowan View using Microsoft excel tool created by author. Descriptive statistics were used to analyse data. RESULTS: There were 27 patients included in the study from four different learning disability wards in Rowan View Hospital. In all but one (96.3%), side-effects to antipsychotics were assessed at least once in 12 months, but formal assessment using a rating scale was conducted in only 88.5%. In majority of patients, only one assessment was done in 12 months (43.8%) whilst the maximum was 3 assessments in a year in 34.8%. None of the assessments had the grade of staff noted whilst only 8.7% assessments were scored despite 91.3% being calculated and only 26.1% assessments even reviewed further. All patients reported side-effects to some extent. CONCLUSION: The modality and frequency of reviewing side-effects to antipsychotics in this neuro-sensitive patient population was noted to be inadequate. The practice of using LUNSERS appears to be completed only superficially with questionable delivery and review of results. There is no formal guideline available nation-wide for basing this assessment of side-effects despite STOMP actions (other than suggestions) and a real deficit was identified. A creation of a formal guideline for monitoring side-effects in patients with Learning Disability is needed and is currently being addressed by Rowan View Patient Safety Team.