Book contents
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
80 - Attention-deficit hyperactivity disorder: prescribing
from VII - Treatment
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
Summary
Setting
This audit is intended for a child and adolescent mental health service (CAMHS) involved in the initiation and monitoring of medications prescribed for attentiondeficit hyperactivity disorder (ADHD).
Background
The diagnosis of ADHD is frequently made but still controversial. In children, it involves difficulties with concentration, excessive motor activity and impulsivity in a variety of environments (National Institute for Health and Clinical Excellence, 2008). Alongside behavioural interventions, medications are an important form of treatment and can be taken as short- or long-acting preparations. First-line treatments are stimulants (methylphenidate or dexamfetamine) or atomoxetine.
Standards
Audit criteria were based upon the National Institute for Health and Clinical Excellence's Technology Appraisal 98, Methylphenidate, Atomoxetine and Dexamfetamine for ADHD in Children and Adolescents (2006). This document looks specifically at ADHD medications. The target for meeting all standards was 100%.
ᐅ Drug treatments in ADHD are initiated by an appropriately qualified healthcare professional with expertise in ADHD. (In our locality, this could be either a CAMHS consultant or a paediatrician with specialist experience. In other regions, specialist nurses or pharmacists may also be able to initiate these medications.)
ᐅ Drug treatment is based on a comprehensive assessment and diagnosis. This was taken to require at least three assessments and use of a common rating questionnaire, for example the Conner's rating scale.
ᐅ Where drug treatment is appropriate, methylphenidate, atomoxetine or dexamfetamine is offered.
ᐅ The decision regarding choice of product considers:
▹ the presence of comorbid conditions
▹ adverse effects
▹ specific compliance issues
▹ the potential for drug diversion or misuse (stimulant medications are controlled substances and could be used illicitly by the patient or others)
▹ preferences of the child and parents or guardians.
Method
Data collection
Prescribing information was taken from multidisciplinary case notes from two sites. The sample included all the available notes (a total of 48 patients).
Data analysis
Outcomes were defined by how closely the standard met the target for completion. Comparisons were descriptive rather than statistical.
Resources required
People
The data could be collected by one person. If multiple sites are used, local collection can be performed by different individuals and later analysed as a whole.
Time
Data collection can take place over any period of time.
- Type
- Chapter
- Information
- 101 Recipes for Audit in Psychiatry , pp. 191 - 192Publisher: Royal College of PsychiatristsPrint publication year: 2011