Monitoring and documentation of side effects from depot antipsychotic medication: an interdisciplinary audit of practice in a regional mental health service

Abstract

Accessible summary The aim of this audit was to review current practice within a rural mental health service area on the monitoring and documentation of side effects of antipsychotic depot medication. While many aspects of the audit highlighted deficiencies in the monitoring and recording of side effects of depot antipsychotic medication, some other areas of practice revealed encouraging results. The audit highlighted the need for improved clinical documentation and the need for a consistent approach to the assessment of side effects and movement disorders using valid and reliable assessment scales and the need for adequate information for service users and their carers. The need to gain service users' consent has also been highlighted. However, the audit did not address consumer insight into their illness which would impact on the giving of consent and adherence to medication and is worthy of exploration in future audit. In addition, the gap in prescribing and medical reviews requires addressing. A recommendation from the audit is the need to introduce simple checklists. The Glasgow Antipsychotic Side Effects Scale, which takes only 5 min to complete and is available freely in the public domain for use, has been chosen for adoption in the service area. Another simple scale, the Simpson Angus Scale, will also be introduced to assess movement disorders. Collaborative practice with feedback from service users is essential in service improvement and care delivery. This approach will be formally incorporated into future care delivery in the service area. Abstract This audit reviewed current practice within a rural mental health service area on the monitoring and documentation of side effects of antipsychotic depot medication. A sample of 60 case files, care plans and prescriptions were audited, which is 31% of the total number of service users receiving depot injections in the mental health service region (n= 181). The sample audited had a range of diagnoses, including: schizophrenia, schizoaffective disorder, bipolar affective disorder, depression, alcoholic hallucinosis and autism. The audit results revealed that most service users had an annual documented medical review and a documented prescription. However, only five (8%) case notes examined had documentation recorded describing the condition of the injection site, and alternation of the injection site was recorded in only 28 (47%) case notes. No case notes examined had written consent to commence treatment recorded. In 57 (95%) of case notes, no documentation of recorded information on the depot and on side effects was given. The failure to monitor and record some blood tests was partly attributed to a lack of clarity regarding whose responsibility it was. A standardized checklist has been developed as a result of the audit and this will be introduced by all teams across the service.

Medication Monitoring in a Nurse-Led Respiratory Outpatient Clinic: Pragmatic Randomised Trial of the West Wales Adverse Drug Reaction Profile

“…This paper suggests that medication monitoring profiles support nurse-led medication monitoring [79], improving the process of care, focusing attention and reducing adverse events in health care [104]–[107]. However, more evidence is needed on the long-term effects of structured medication monitoring on clinical outcomes [41], nursing vigilance, nurses’ workload, nurses’ and service users’ time, and acceptability [20], [39], [40], [108]–[112].…”

Adverse Side Effects of Psychotropic Medication and Challenging Behavior: Pilot Work Assessing Impact

“…However, the means with which we objectively evaluated ASEs may still provide valuable clinical information for the treatment of individuals with IDD. Objective evaluation is valuable because research has demonstrated that current tools relying on third-party subjective/anecdotal reports over- and/or underestimate the presence of ASEs (Cleary et al, 2012). Using direct and objective measures of ASE presence may facilitate better pharmacological treatments but also inform behavioral programming.…”

“…However, these measures (e.g., Likert scales) may not measure accurately ASEs in those with IDD with communication impairments (Matson & Neal, 2009). Other instruments may be ineffectively time-consuming, unreliable, or invalid (Cleary et al, 2012). Furthermore, indirect measures rely on rater subjectivity rather than objective observations.…”

Validation of the Glasgow Antipsychotic Side-Effect Scale (GASS) in Greece

“…Locally developed checklists scales were used in 25% of the case notes examined, this percentage is low when considering the popularity of using an evidenced-based tool in practice, for example, the Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) [25]. He concluded that Collaborative practice with feedback from service users is essential in service improvement and care delivery [43].…”

“…Adverse effects of antipsychotics are often neither diagnosed nor treated [43]. In his audit, Cleary A [43] investigated current practice within a rural mental health service area on the monitoring and documentation of side effects of antipsychotic depot medication.…”