Antipsychotic medication monitoring

Improving physical health on older-adult in-patient psychiatric wards

Improving
physical health
Departments> Pharmacy and medicines management> Formulary and
prescribing guidelines > 11 Monitoring guidelines > 11.1 Psychotropic
monitoring guidelines
Charlotte.allan@oxfordhealth.nhs.uk
Anti-psychotic medication monitoring:
Baseline, 3 monthly and annually.
Graph 1: Percentage of patients on antipsychotics for less than 3 months receiving
baseline monitoring tests
Jan 2012 blue (n=9); May 2012 red (n=10)

Graph 2: ercentage of ant|-psychot|c mon|tor|ng tests done per pat|ent |mproved at a||
three t|me po|nts

Overview of the Project

Antipsychotic drugs can lead to early death, particularly due to
stroke. Older-adults, especially those with dementia, are most
vulnerable. When starting antipsychotic medication, physical health
checks are performed at baseline, 3-months, 6-months and 12-
months. This allows any adverse effects to be detected (and ideally
prevented) at an early stage. Doing this requires multi-disciplinary
co-ordination from doctors, nurses and pharmacists.
Poor physical health is common in patients with mental illness and
has an adverse effect on behaviour and recovery. Excellent physical
health care is therefore needed on in-patient psychiatric wards and is
particularly important for older-adults.
Leadership Challenges
I wanted to communicate my vision of improved physical health. I
focussed on raising awareness of the importance of antipsychotic
medication monitoring, to provide a rationale for change which would
motivate clinicians to improve their practice. I worked closely with a
project team so that information could be readily cascaded across
three sites. Engaging this multi-disciplinary group of clinicians was
essential, to ensure the success of the project.
Results
Information was communicated to wards and individuals through:
guideline sheets, posters, emails and face-to-face discussions. This
raised awareness of why and what monitoring was needed. Simple
changes e.g. pre-printed sticky labels for blood cards, helped to
improve blood monitoring levels and promote safer practice. A
monitoring proforma provided clarity about the physical health
checks needed, and enabled clear documentation of outcomes.
This led to improvement in nearly every measure (graph 1). Overall,
the percentage of tests done per patient improved at all three key
time points (graph 2). This success was communicated to all
clinicians (with guidance about room for further improvement!).
Contact Information
Dr Charlotte Allan
Specialty Trainee in Old Age
Psychiatry
Charlotte.allan@psych.ox.ac.uk
01865 223786
I led simple changes to existing systems to make it easier for
clinicians to undertake and record antipsychotic medication
monitoring. This aimed to empower clinicians to change their
behaviour, and to build a sustainable system.