Audit of a recently introduced stimulus dosing policy in an electroconvulsive therapy clinic

Abstract

Aims and methodTo audit the clinical practice of seizure threshold estimation and subsequent stimulus dose adjustment in the electroconvulsive therapy (ECT) clinic. Case notes of patients who had ECT over a six-month period were audited. Results were discussed at an audit meeting and guidelines and training modified appropriately prior to the second cycle of the audit.ResultsInitial dose titration was poor in the first period, but improved in the second. The majority of patients were insufficiently stimulated after missed seizures in both periods and stimulus doses were not being reduced following prolonged seizures.Clinical implicationsThe audit identified the need for continuing supervision of trainees in addition to clear training and guidelines.

Running an ECT department

“…Published audits from colleagues have shown that the introduction of more complex ECT techniques is not easy (Yousaf et al, 1999) and have identified the need for continuing supervision of trainees (Shaikh et al, 1999).…”

Audit of an electroconvulsive therapy clinic's missed-fit rate

“…No changes in the stimulus dosing policy or re-stimulation protocol were made during the 6-year audit period. Reports from other ECT clinics about attempts to improve efficiency have stressed the importance of regular supervision by senior psychiatrists (Trezise & Conlon, 1997), particularly when a stimulus dosing policy is introduced (Shaikh et al, 1999).…”