Abstract
Quality improvement in remote prescribing
Highlights
It was highlighted that current practice was not in line with NMC guidance of the time as no follow-up written instruction by a doctor was received
(>3 months) 15% would request Benzodiazepines for treatment of psychotic symptoms 12% would request Lorazepam above British National Formulary maximum doses As required medications dispensed per shift 54% report 0 to 3 times 23% report 4 to 6 times 23% report 6 to 10 times Agitation was most commonly defined as 96% hostile behaviour/physical aggression 92% hostile/threatening/derogatory speech 81% visible anxiety 69% disturbed behaviour that is not threatening/derogatory towards others 31% patient reported anxiety without objective evidence PRN medication use reviewed by doctors Daily (8%) Weekly (85%) Monthly (8%) 5 most commmonly cited reasons contributing to PRN medication use 77% Ward atmosphere 69% Patient depdence 54% Patient expectation 42% Limitted expectation of benefit from psychological skill utilisation 42% Usual habit/culture of prescribing by doctors What are your thoughts on the use of psychological interventions in an acute setting? [Open Ended, n = 22]
Concerns were raised about the general safety of verbal communication of prescriptions out of hours
Summary
Of 690 patients 51 patients had the diagnosis of Bipolar Affective Disorder. 49 percent of them were prescribed Lithium. 48percent had their Lithium bloods checked and 60 percent had their Kidney function and thyroid functions checked according to the guidelines. There were no data available for around 7 percent of patients but their Lithium levels were indicated only in Clinical notes. This audit has demonstrated that Lithium monitoring falls short of conforming to accepted standards. Data obtained by this audit have prompted an electronic alert system for patients on Lithium endorsing primary care, mental health and laboratory staff to work together to ensure supporting recommended Lithium monitoring
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