Compliance With Nice Policy on Ecg in Patients on Psychotropic Medications: Frays Ward August 2020 to January 2021
Authors: Adegbite Olajide , Seneviratne Saal , Patel Ruchit 
Published: July 2023

Aims

1. The need to ensure ECG is done before commencing Psychotropic medications. 2. The need to ensure both medical and non-medical staff cooperate in ensuring ECG monitoring is done according to guidelines. 3. The need to help Nurses acquire competence in performing ECG

Methods

A total of 101 patients were reviewed, all with various diagnoses, cardiovascular risks, and on different medications. Of these, 61 were included while 40 were excluded.

The exclusion criteria include:

1.

Transfer from another trust to Frays ward

2.

Transfer or step down from ICU to Frays ward

3.

Transfer from frays ward on the day of admission

4.

Patients who are already on treatment and recently had physical health assessments.

5.

Admitted before August and after January

Some of the patients were already known to mental health services and had been on medications. While others were having contact with mental health services for the first time.

After the exclusion, only about 61 patients were included in the study over the 5-month period.

Data were collected on the following:

1.

Date of admission

2.

Date ECG was done.

3.

Date medication was commenced.

4.

QTc readings

5.

Type of medication commenced.

6.

Days between admission and completion of ECG were extrapolated.

7.

Days between admission and commencement of medication were also extrapolated.

All the above data were analysed and presented in charts, tables, and graphs.

Some Limitations identified:

Lack of standard admission register

Lack of discharge register

Missing ECG reports

Recruitment and participation of team members due to multiple training activities on Frays

Results

1.

A total number of 48 patients had ECG while 13 of them did not. Some refused to give consent or were not mentally/clinically stable.

2.

A total of patients that had Baseline ECG before the commencement of medications on admission was 22(36%), while 39(64%) had ECG after the commencement of medications. The vast majority of the non-compliant patients were due to failure to consent at the time of admission.

3.

Timeline for Baseline ECG vs commencement of medications: 16 patients had within 24 hours, 10 patients had after 24 hours, 16 patients had within one week and 4 patients had after one week.

4.

Concerning QTc pattern; A total of 37 patients had normal, 10 patients had borderline and 1 had prolonged

5.

Patients with other ECG abnormalities: Out of the 48 patients that had ECG at one point during the admission, about 44 of them had a Normal sinus rhythm while 4 were abnormal. However, all the abnormal ECGs were asymptomatic

Conclusion

Although the vast majority of service users in this study had normal ECG readings and overall low cardiovascular risk, the compliance rate with Trust/NICE guidelines are significantly low. Apart from falling short of Trust and NICE policies, this increases the chances of missed diagnosis, especially in people with pre-existing cardiac conditions.

Efforts must be intensified to ensure the vast majority of service users get thorough physical health assessments including ECG before psychotropic medications are commenced.