Physical Health Assessment and Monitoring for Adults Receiving Pharmacological Treatment for ADHD in an Adult CMHT:Clinical Audit

Abstract

AimsADHD diagnoses have skyrocketed in the recent times resulting in a lot of the patients being on stimulant medications. NICE guidelines recommends a baseline review of physical health which should include height, weight ,baseline pulse and blood pressure and a cardiovascular assessment before starting these medications. It also recommends 6 monthly monitoring of weight, blood pressure and pulse. We aimed to assess the current practice of baseline and 6 monthly physical health monitoring against the standards set by NICE guidelines.Methods33 random case notes were identified from the adult CMHT who had a diagnosis of ADHD and were receiving stimulant medications. An audit pro-forma was designed to collect data on baseline blood pressure, pulse, weight ,cardiovascular assessment before commencing treatment and 6 monthly monitoring of Blood pressure, Pulse and weight. The data were collected over a period of 3 months between October 2022 and December 2022.The results were presented in the local CMHT meeting and a new proforma was designed for baseline and follow-up physical health assessment which will be incorporated in the case notes. A re-audit is planned in March 2023.ResultsThere were 16 females and 17 males in the identified cases.19 patients were on different Methylphenidate formulations,8 patients were on Lisdexamfetamine and 6 were on Atomoxetine.19 patients (57%) had documentation of baseline blood pressure, 13 patients (39%) had documentation of baseline pulse,17 patients (51%) had documentation baseline weight and 2 patients (6%) had documented baseline cardiovascular assessment in the case notes.10 out 33 patients had 6 month follow-up visits and monitoring data were collected from them. None of the patients (0%) had documentation of blood pressure, pulse or weight in the case notes.ConclusionThe adherence to NICE guidelines was low in physical health monitoring as hypothesized by the team. A new proforma for baseline and 6 monthly physical health monitoring is developed by the audit team which is aimed to increase awareness about the physical health monitoring amongst the clinicians. The need for improving this practice is crucial due to increasing number of patients on these medications and the risk of serious side effects.