An audit of physical examinations in a Psychiatric Intensive Care Unit

A brief intervention to improve rates and quality of physical examinations for admissions to acute adult psychiatry units

OBJECTIVE

To determine the frequency and quality of physical examinations within 24 h of admission to an acute adult psychiatry unit, and whether a brief intervention involving feedback to clinicians could lead to improvement.

METHOD

Retrospective review of the electronic medical records followed by four brief feedback sessions and email correspondence, followed by a further review of the medical records 1 month later.

RESULTS

The proportion of patients receiving a physical examination increased from 36/71 (50.7%) in the initial audit to 41/64 (64.1%) in the re-audit. The mean score of the quality of physical examinations improved from 7.5 to 9.3 (out of 15). The greatest improvement on re-audit occurred in the documentation of additional cardiac sounds (33.9% increase), additional breath sounds (17.7% increase), breath sounds (17.1% increase), cardiac sounds (14.2% increase) and bowel sounds (12.5% increase).

CONCLUSION

This audit supports the use of brief peer-led feedback to improve the rates and quality of physical examinations.

A Retrospective Chart Review of Screening on the Prevalence of Metabolic Syndrome (MetS) in an Irish Community Mental Health Service

Individuals who are treated with antipsychotic medications are at risk of developing metabolic syndrome (MetS). The comorbidity of a severe mental illness (SMI) and a physical illness has a major impact on the quality of life of these individuals. We conducted a retrospective chart review (RCR) of 214 individuals with a diagnosis of schizophrenia who had been receiving antipsychotic medications for at least 6 months, in five clinical settings in an Irish community mental health service. The aim was to determine the presence of MetS to assist in improving screening practices and directing future practice. The National Cholesterol Education Program High Blood Cholesterol Adult Treatment Panel 111 (NCEP ATP 111) metabolic diagnostic criteria were utilised to determine prevalence. After examining 214 charts we observed that waist circumference varied from 68 to 142 cm, elevated waist circumference over the recommended parameters was recorded in 145 charts. Forty-five percent (n = 98) had blood pressure (BP) readings over 130/85. The range for body mass index (BMI)'s varied from 16 to 54, BMIs over 25 was recorded in 44% (n = 95) of charts. Elevated triglycerides (TG) were recorded in 37% (n = 80) and 45% (n = 97) had reduced HDL-C levels. Elevated glucose levels were found in 25% (n = 54) of the charts examined. The chart review found an overall prevalence rate of 44% (n = 94) for this sample. Regular audit of screening data used for the presence of MetS in individuals with SMI is essential in the detection of physical comorbidities and to improving the quality of life and prevention of premature deaths.