Abstract
AimsThe release of the Cumberlege Report in 2020 served as a reminder of the importance of informed consent for women when they are started on treatment that may affect their fertility or future pregnancies.Our aim was to evaluate current performance with regards to advice given to women of childbearing age around contraception, impacts of psychotropic medication on fertility and future pregnancies, and availability of preconception counselling.MethodStandard identified as NICE Guideline 192 (Antenatal and Postnatal Mental Health), sections 1.2 and 1.4.60 female inpatients were selected by looking at the most recent discharges prior to 03/11/2020 from 3 local acute adult wards. All females aged between 18 and 48 years were included.Electronic notes were reviewed for each patient. The discharge summary and last four ward round entries were reviewed, then key-word search of the patients’ records was performed using the terms “pregnan*”, “conception”, “contraception”, and “fertility”.The following information for each patient was documented in a spreadsheet:Discharge medicationIs there any discussion or advice around contraception?Have women taking antipsychotic medication been given advice regarding the possible impact on fertility?Has the potential impact of psychotropic medication on a future pregnancy been discussed?Has advice been given about the availability of preconception counselling should they plan a pregnancy in future?ResultOn discharge, a total of 33 women were taking one or more antipsychotics and 14 were prescribed a benzodiazepine. 24 women were discharged with antidepressants and 10 women were using a mood stabilising agent. 8 women were discharged without any psychotropic medication.Overall, 4 women received advice about contraception, and a further 8 women were already using contraception. The impact of taking an antipsychotic on fertility was not discussed with any patient. No women were advised about pre-conception counselling. The impact of taking psychotropic medication on a future pregnancy was discussed with one woman.ConclusionCurrent practice falls well below the standard set by NICE. Opportunities to inform women are being missed, and this has implications for the wellbeing of the patient and, potentially, future children.Action plan;Present findings at teaching.Deliver local teaching covering preconception counselling and the role of adult mental health teams when managing women of childbearing age.Produce a poster for inpatients wards and an information leaflet for women of childbearing age to aid with discussions.Create a poster for doctors’ offices to remind about NICE standards and documentation.Re-audit in 6 months.
Highlights
Patients were asked about their smoking status the majority of the time (68%) but provision of advice or nicotine replacement therapy was only done in 14% of potential smokers
A consideration to be taken into account is that on admission, a patient’s physical health status may be unknown, with the additional difficulty of a patient’s acute distress complicating the physical examination, smoking status and modification of patient’s smoking status may not be the highest priory in that context
Data regarding asking about smoking were different amongst wards, potentially signifying differences between assessors willingness to ask about smoking status
Summary
Patients with an SMI are 3–6 times more likely to die due to coronary artery disease. 70% of patients in inpatient psychiatric units are smokers, a strong independent risk factor for cardiovascular disease. 70% of patients in inpatient psychiatric units are smokers, a strong independent risk factor for cardiovascular disease. Smoking cessation is a potent modifiable risk factor that can prevent mortality and reduce morbidity. Patient records were explored using the Aneuran Bevan Health Board admission proformas to identify evidence of smoking status and whether advice was offered. Patients were asked about their smoking status the majority of the time (68%) but provision of advice or nicotine replacement therapy was only done in 14% of potential smokers (identified smokers and patients not asked about smoking status). Data regarding asking about smoking were different amongst wards, potentially signifying differences between assessors willingness to ask about smoking status. The audit determined whether or not assessors were documenting smoking status, it does not measure the quantity or quality of smoking cessation advice provided. Further quality improvement projects should be launched, with focus groups as the intial step at further investigating inpatient smoking rates, as well as attempting to reduce them in a more systemic way
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