Second opinion medication audit cqc
-
Upload
nhs-improving-quality -
Category
Healthcare
-
view
327 -
download
2
description
Transcript of Second opinion medication audit cqc
Second Opinion Medication Audit
A post-Winterbourne audit of second opinion requests and certificates for learning disability patients detained under
the Mental Health Act
Method• Collected data between Oct 12 – Aug 13
• Identify patients with learning disabilities.
– Analysing diagnosis and ward location– Data included both inpatient and community based (CTO)
• Audit the medication of every case.
– Antipsychotics– Antidepressants– Polypharmacy– High Dosage
• Analyse qualitative data in the form of the treatment rationale.
Definitions
• Polypharmacy– Use of any drug class which has more than one member authorised.– Considered both regular and potential.
• Polytherapy– Use of multiple category medicines within a treatment plan.– E.g. 4.2.1, 4.3.3, 4.1.2, 4.9.2
• High Dosage– Medication (either by itself or combination of ≥2 of same category)
which exceeded 100% of the BNF maximum for a single medicine.– Considered both regular and potential.
Audit Tool
• Key Themes Identified.1. Treatment link with disorder2. Risks/Benefits of treatment3. Evidence for diagnosis4. Consideration of previous medication5. Use of alternative therapies
• Applied to 2 parts of data set:– Section 58 proposed treatment rationale– SOAD certificates
Quantitative Demographics• 796 individuals required a SOAD in the period of Oct
12 to Aug 13. 672 (84%) assessed once.
• Majority of cases were male, totalling 532 (66%).
• 590 (74%) of cases were White British. Second largest group was not specified 101 cases (12%).
• Large age range of 12-89 though average age was 34.
Provider Prescribing Data
Medication % Prescribed % Polypharmacy
Antipsychotic 858 (91%) 379(44%)
Anxiolytic 776 (82%) 220 (28%)
Mood Stabiliser 449 (48%) 106 (24%)
Antidepressant 318 (34%) 14 (4%)
• Number of cases prescribed polypharmacy = 534 (57%)
Regular Prescribing Data
Medication % Regularly Prescribed % Regular Polypharmacy
Antipsychotic 814 (86%) 132(16%)
Anxiolytic 284 (30%) 8 (3%)
Mood Stabiliser 444 (47%) 106 (24%)
Antidepressant 316 (33%) 14 (4%)
• Number of cases prescribed regular polypharmacy = 250 (24%)
Prescribing Comparisons
Provider Data
– Polypharmacy• 51% (NHS) vs. 63% (Independent)
– ≥5 medications• 31% (NHS) vs. 49% (Independent)
Ward Data
– Polypharmacy• 58% (LD) vs. 55% (Non-LD)
– ≥5 medications• 40% (LD) vs. 40% (Non-LD)
High Secure Hospitals Prescribing
• Only 10 cases analysed.• On average fewer medications in a treatment plan.• 4 cases prescribed a depot.• 1 case prescribed treatment featuring polypharmacy.
• Why?– High proportion primarily diagnosed with personality disorder
(Thompson 2000)– Staff training specialised in de-escalation (Thompson 2000)– Longer length of stay possibly allows for rationalisation of
medication.
Community Prescribing
• 52 community treatment order (CTO) cases analysed.
• Fewer medications per treatment plan with only 6 (11%) treatment plans containing ≥5 medications.
• 10 (21%) cases were prescribed treatment plans featuring polypharmacy.
• Deb et al. (2013) similar number of cases though proportionately smaller.
Adolescent Prescribing
• 43 adolescent cases analysed.
• Higher average of number of medications per treatment plan.– 42% prescribed ≥5 medications.
• 51% were prescribed treatment plans featuring polypharmacy.
• Rates of polypharmacy rising in adolescents (Spencer et al., 2013)
Qualitative: Provider
• Detail focused on treatment as opposed to context for
which it was needed.
• Benefits of treatment were presented as preventing
deterioration (in behaviour).
• Evidence for diagnosis was sparse.
• Previous treatments, effective or not, rarely referred to.
• Alternative therapies were not recorded.
Summary
• Analysed 945 cases.
• 24-57% of cases prescribed polypharmacy.
• Independent providers prescribing greatly differed from NHS.
• Variance between subpopulations within sample.
• Rationalisation were better for smaller treatment plans.