Published online Mar 22, 2018. doi: 10.5498/wjp.v8.i1.27
Peer-review started: October 27, 2017
First decision: December 11, 2017
Revised: December 29, 2017
Accepted: January 16, 2018
Article in press: January 16, 2018
Published online: March 22, 2018
To ascertain performance against the standards set by National Institute for Clinical Excellence (NICE) guidelines on physical health monitoring of thirty children and adolescents prescribed antipsychotics in neurodevelopmental clinics in Northumberland and identifying areas for improvement in practice.
The audit involved a review of recorded documentation pertaining to physical health monitoring in patient electronic records pertaining to children and adolescents attending neurodevelopmental clinics in Northumberland prescribed antipsychotics. Clients were also contacted by telephone if relevant documentation could not be identified or retrieved to confirm the details. 32 case notes were perused of which 2 were excluded as they had refused to have venepuncture which was documented in the electronic records.
The overall audit results demonstrated partial compliance with NICE guidelines on physical health monitoring in children and adolescents prescribed antipsychotics. Bi-annual recording of height, weight, blood pressure, pulse rate and review of side effects was completed in 100% of subjects. However, annual monitoring for blood tests including liver function, renal function full blood count as well as biannual monitoring of serum prolactin, serum lipid profile was completed only in 56% of subjects. Comparative baseline characteristics between the two groups (compliant and non-compliant with guidelines) found no differences based on any socio-demographic or clinical variables. However, the proportion of patients in the group compliant to guidelines was higher in the age group of 12-17 years as compared to < 12 years (70.58% vs 38.46%), though not statistically significant (χ2 = 1.236; P = 0.24).
Development of tailored and specific guidelines for physical health monitoring in children and adolescents prescribed antipsychotics taking into consideration clinical effectiveness and safety profile is likely to improve adherence rates.
Core tip: A number of clinical guidelines have been developed for physical health monitoring in children and adolescents on antipsychotics. However, none of them capture the intricacies and complexities involved in prescribing antipsychotics to children and adolescents, which is distinct from adults. The typically shorter duration of prescribing, lower doses used and lack of data on long term adverse effects with antipsychotics in this population have not been taken into account. This audit aimed to ascertain if physical health of children and adolescents attending neurodevelopmental clinics in Northumberland and prescribed antipsychotics followed National Institute for Clinical Excellence guidelines. The overall audit findings were partially compliant with the guidelines. Logistic and ethical challenges as well as lack of awareness about the guidelines could underpin these findings.