Pasha Nida, Saeed Shoaib, Drewek Katherine
St Georges Hospital London.
BMJ Qual Improv Rep. 2015 Jun 17;4(1). doi: 10.1136/bmjquality.u202645.w3700. eCollection 2015.
Physical health monitoring of patients receiving antipsychotics is vital. Overall it is estimated that individuals suffering with conditions like schizophrenia have a 20% shorter life expectancy than the average population, moreover antipsychotic use has been linked to a number of conditions including diabetes, obesity, and cardiovascular disease.[1-4] The severity of possible adverse effects to antipsychotics in adults has raised awareness of the importance of monitoring physical health in this population. However, there is little literature available as to the adverse effects of these medications in the child and adolescent community, which make physical health monitoring in this predominantly antipsychotic naïve population even more important. An expert group meeting in the UK has laid down recommendations in regards to screening and management of adult patients receiving antipsychotics, however no specific guidelines have been put in place for the child and adolescent age group.[5] The aim of this audit was to establish whether in-patients receiving antipsychotics had the following investigations pre-treatment and 12 weeks after treatment initiation: body mass index, hip-waist circumference, blood pressure, ECG, urea and electrolytes, full blood count, lipid profile, random glucose level, liver function test, and prolactin. This is in addition to a pre-treatment VTE risk assessment. These standards were derived from local trust guidelines, NICE guidelines on schizophrenia [6] and The Maudsley Prescribing Guidelines.[7] We retrospectively reviewed 39 electronic case notes in total, of which 24 cases were post intervention. Intervention included the use of a prompting tool. This tool was filed in the physical health files of all patients receiving antipsychotics which was intended as a reminder to doctors regarding their patient's need for physical health monitoring. Professionals involved in the monitoring of such parameters were educated in the importance and purpose of its use. Following this intervention re-audit occurred after 6 and 16 months of the initial audit to establish whether the use of the prompting tool caused any significant change in clinical practice. Overall performance in monitoring physical health parameters was initially poor, however we were able to demonstrate that with the help of a single prompt sheet there was a significant improvement following post intervention audit for the majority of parameters being monitored.
对接受抗精神病药物治疗的患者进行身体健康监测至关重要。总体而言，据估计，患有精神分裂症等疾病的个体预期寿命比普通人群短20%，此外，使用抗精神病药物与包括糖尿病、肥胖症和心血管疾病在内的多种疾病有关。[1-4] 成人使用抗精神病药物可能产生的不良反应的严重性提高了人们对该人群身体健康监测重要性的认识。然而，关于这些药物在儿童和青少年群体中的不良反应的文献很少，这使得在这个主要未使用过抗精神病药物的人群中进行身体健康监测变得更加重要。英国的一个专家组会议已经就接受抗精神病药物治疗的成年患者的筛查和管理提出了建议，然而，尚未针对儿童和青少年年龄组制定具体指南。[5] 本次审核的目的是确定接受抗精神病药物治疗的住院患者在治疗前和开始治疗12周后是否进行了以下检查：体重指数、臀围腰围、血压、心电图、尿素和电解质、全血细胞计数、血脂谱、随机血糖水平、肝功能检查和催乳素。此外还包括治疗前的静脉血栓栓塞风险评估。这些标准源自当地信托指南、英国国家卫生与临床优化研究所（NICE）关于精神分裂症的指南 [6] 以及莫兹利处方指南。[7] 我们总共回顾了39份电子病历，其中24例是干预后病例。干预措施包括使用提示工具。该工具存放在所有接受抗精神病药物治疗患者的身体健康档案中，旨在提醒医生其患者需要进行身体健康监测。参与此类参数监测的专业人员接受了关于使用该工具的重要性和目的的培训。在此次干预之后，在首次审核后的6个月和16个月进行了重新审核，以确定提示工具的使用是否在临床实践中引起了任何显著变化。在监测身体健康参数方面，最初的总体表现较差，然而，我们能够证明，借助一张提示单，在干预后审核中，大多数被监测参数都有了显著改善。
