Following the publication of the 1994 Consensus Statement on the use of high-dose antipsychotic medication, we identified our high-dose patients and undertook an audit of the recommended physical investigations. The patients were identified by scrutiny of prescription records. Data were collected retrospectively at six-monthly intervals for four audit cycles. Results were fed back to clinicians at the hospital journal club.
The percentage of patients identified in the high-dose category fell from 35 to 23% over 18 months. Electrocardiograph monitoring of the group increased from 5 to 63%. Other tests showed a similar improvement. A very small number of abnormal results was shown. There were no untoward cardiac events.
Introduction of the standards of physical monitoring advised in the Consensus Statement has implications of cost to the NHS to be balanced against risk avoidance for patients. The number of abnormalities detected in our population was low. Changing prescribing behaviour in response to reported abnormal findings proved unexpectedly slow and a new system was required.
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