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
92 - Mood stabilisers: monitoring
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 relates to all services where patients are treated for bipolar affective disorder or otherwise prescribed mood stabilisers. It relates to both in- and out-patients.
Background
The mood-stabilising drugs valproate and carbamazepine are widely prescribed within psychiatric services and each has its own list of potentially harmful adverse effects. (Lithium monitoring is considered in audit 90, p. 211.) As a result, there are important monitoring recommendations for both drugs. These include monitoring of the possible side-effects, as well as therapeutic drug monitoring, which aims to avoid the side-effects while ensuring therapeutic levels of the drug are achieved.
Standards
Standards for audit were obtained from the guideline on bipolar disorder produced by the National Institute for Health and Clinical Excellence (NICE) (2006):
ᐅ Patients prescribed valproate should have the following baseline assessments prior to initiation of treatment:
▹ liver function tests (LFTs)
▹ full blood count (FBC)
▹ weight and height.
ᐅ Patients prescribed valproate should have LFTs and FBC rechecked 6 months after initiation of treatment.
ᐅ Patients prescribed carbamazepine should have the following baseline assessments prior to initiation of treatment:
▹ LFTs
▹ FBC
▹ weight and height.
ᐅ Patients prescribed carbamazepine should have:
▹ LFTs, urea and electrolytes (U&Es) and FBC checked 6 months after initiation of treatment
▹ U&Es monitored every 6 months subsequent to this
▹ serum carbamazepine levels measured every 6 months.
It was expected that the standards would be met for 100% of patients.
Method
Data collection
A list of patients prescribed valproate or carbamazepine was created by examination of in-patient medication charts and out-patient records held in the pharmacy. The medical notes and online pathology results for each of these patients were then examined to determine which monitoring tests had been carried out over a previous defined period.
Data analysis
The percentage of patients who had undergone each test applicable to them was calculated and these percentages compared against the standards set above.
Resources required
People
Owing to the volume of notes to be read and the amount of data to collect and analyse, it is suggested that two people undertake this audit. It is appropriate that different disciplines are involved (e.g. a doctor and a pharmacist).
- Type
- Chapter
- Information
- 101 Recipes for Audit in Psychiatry , pp. 215 - 216Publisher: Royal College of PsychiatristsPrint publication year: 2011