Compliance Audit on Diagnosis and Treatment of Folate and Cobalamin (Vitamin B12) Levels in CAMHS Transition Service at Oldham, a Full Cycle Audit

Abstract

AimsTo investigate compliance with British Society of Haematology (BSH) guidelines and NICE clinical summarieson diagnosis and treatment of folate and cobalamin deficiencies in CAMHS Transition service, Oldham.MethodsThe standards used were based on BSH guidelines and Nice clinical summaries, with targets for all 100%: 1.Haemoglobin concentration and mean corpuscular volume (MCV) checked at the same time as assay for serum cobalamin and folate.2.Cobalamin and folate assays should be assessed concurrently due to the close relationship in metabolism.3.Treatment of established cobalamin deficiency should follow the schedules in the BNF.4.All patients with anaemia, neuropathy or glossitis, and suspected of having pernicious anaemia, should be tested for anti-IFAB regardless of cobalamin levels.5.Patients found to have a low serum cobalamin level in the absence of anaemia and who do not have food malabsorption or other causes of deficiency, should be tested for IFAB to clarify whether they have an early/latent presentation of pernicious anaemia.6.Treatment of folate disorders should follow the schedule in the BNF.7.We reviewed all open cases to Transition service in Oldham. Their NHS number was checked through the pathology laboratory portal. In addition, notes on Paris electronic system and digital letters were checked to see if results were acknowledged. The initial audit period run from February 2021 to April 2021.The results were shared with the Multidisciplinary Team and an algorithm was created and shared in an attempt to improve the practice. The re-audit run from May 2022 to July 2022. A total of 80 patients were included in the audit and 25 patients in the re-audit. We entered and analysed our data using Microsoft excel.ResultsCompliance levels for the standards for the audit were as following: standard number 1, 2 and 5 were 100%, number 3 and 6 were 0%, and number 4 was not applicable.Compliance levels for all the standards were 100% for the re-audit.ConclusionThe results of the initial audit indicate that not all standards were met. However, results of the re-audit indicate all standards were met. It appears implemented changes may have affected the outcome of results. However, as the sample of patient was small might need to repeat this audit cycle in the future to see if the results remain the same.The physical health protocols are relevant to psychiatric practice and the algorithm can be disseminated for further use.