Administration of ‘when required’ psychotropic medicines in mental health units : Documentation of reason for administration and effect of psychotropic medicines administered ‘as required’ in adult mental health inpatient units Setting Study period No. given a prn dose (%) No. of prn doses given prn with appropriate documentation in case notes (%) Reason for administration Person initiating the medicine Medication effect Geffen1 Inpatient mental health units from two Brisbane hospitals Dec 1999 302 (82%) 1,786 1,054 (59%) 643 (36%) Curtis Secure nine-bed inpatient mental health unit, NSW Oct 2001 43 (80%) 450 409 (91%) 276 (61%) 264 (59%) Dean (91)2008. 12-bed child and adolescent inpatient mental health unit, Brisbane Apr 2003 62 (51%) 42 patients (68%) Curtis 20-bed inpatient mental health unit, regional hospital in NSW Feb 2005 47 (73%) 268 154 (57%) 104 (39%) O’Brien Eight-bed close observation area within an inpatient mental health unit. One month period; year not recorded 15 119 96 (81%) 91 (76%) Inpatient mental health units from a regional and metropolitan hospital in QLD One month period; year not recorded 57 (63%) 268 170 (63%) 204 (76%) 120 (45%) Four inpatient mental health units, Sydney Two month period; year not recorded 408 (97%) 3868 2,445 (63%) 2,766 (72%) ≈50% Sept
geriatric psychiatry (n=321) Restifo103 Retrospective audit of discharge medication for patients with behavioural and psychological symptoms of dementia discharged from three inpatients units in Perth (n=89) July 2008 – June 2009 4/52 (8%) Clients with an intellectual disability McGillivray People with an intellectual disability who were subjects of report to the Intellectual Disability Review Panel concerning use of chemical restraint (n=873) 2000 70 (8%) Doan self-reported data taken from a Randomised Control (the Advocacy and Health 2000 – 2002 3/24 (12%)
Study) among adults with intellectual disability, Brisbane (medicines use reported for 117/138 RCT participants) Community-based studies Callaly187 Audit of 792 patients managed by a regional community mental health service, Victoria. (n=572 taking an antipsychotic) April 1999 Conventional oral + atypical oral: 19 (3%) Conventional depot + atypical oral: 9 (2%) Two oral atypical antipsychotics: 5 (1%) Bains14 Audit of 40 patients from three supervised group homes in the community. Treatment resistance not defined unknown 8 (20%) received conventional + oral atypical antipsychotics Lowe Audit of 38 patients receiving intensive case management from a community mental health centre in Melbourne. Patients received ≥52 contacts with the service yearly Jan 1998 – March 2003 9 (24%)
atypical antipsychotic, with 5% taking clozapine + atypical + conventional audit of patients taking clozapine (n=84) who were treated by one of 12 clinicians in a regional area of NSW May 2011 46 (55%) took one antipsychotic 5 (6%) took two other antipsychotics Vecchio19 Retrospective audit of patients with psychotic illness treated for one year by the Assertive Community Team (ACT) in metropolitan Western Australia (n=38) 2012 – 2013 16 (42%) Children and adolescents Dean Retrospective audit of charts for 122 inpatients from a child and adolescent mental health service in Brisbane Apr 2002 – Sep 2003 2/38 (5%) received atypical + conventional
Cardio-metabolic monitoring Table : Percentage of patients receiving antipsychotics who were monitored for risk factors Study Patients and setting period No. of patients Received recommended monitoring (%) Weight Girth Lipids BSL Blood pressure Nguyen Patients with schizophrenia discharged from three public psychiatric hospitals Oct 2005 93 65 (65%) 0 (0%) 7 (8%) 29 (31%) 2 (2.2%) Not reported Sazhin25 Males with major mental illness treated involuntarily in a forensic hospital July 2003 & Jan 2006 44 17 (39%) Wilson Randomly selected patients prescribed clozapine mental health, centre Dec 2011 107 49% Not reported 13% 13% Not reported 16 Ellis Children admitted to hospital and prescribed antipsychotics for >1 month 54 10 (19%) had a monitoring chart 4 (7%) were monitored as recommended BSL: Blood sugar level; HbA1c: Haemoglobin A1c. Table : Percentage of adults with psychosis with cardio-metabolic risk factors Study n % of patients with risk factors Tobacco use Sedentary lifestyle Increased blood pressure Overweight/ obese Abdominal obesity Increased blood sugar level Increased lipids Gladigau124 60 67 Not reported 40 50 = obese 33 = overweight 84 36 67 Foley 1 642 Not reported Not reported 42 77 82 29 22 Galletly123 1 825 81 97 48 76 82 29 33
Tirupati177 221 Not reported Not reported 83 88 71 64 81 Herriot 261 Not reported Not reported Not reported Not reported Not reported 49 54 Rosenbaum 85 49 Not reported 25 43 43 10 Not reported : Percentage of adults with psychosis with cardio-metabolic syndrome Study Patients and settings period No. of patients % with metabolic syndrome Tirupati177 An of clinical and laboratory assessments of patients with a psychotic disorder attending a rehabilitation centre within the NSW Hunter New England area Unknown 221 68 Galletly123 Randomly selected adults with psychosis in the second Australian survey of psychosis 1,825 55 Wilson Randomly selected patients prescribed clozapine at Metro North Mental Health, Brisbane Dec 2011 155 151 (second time) 68 73 Rosenbaum of young patients presenting to a first-episode psychosis service in Sydney; average age 21 2011 85 11 Gladigau124 A audit of medical files on patients receiving community care in Melbourne May 2012 60 66 Agreed care plans : Percentage of mental health consumers receiving care plans Study Study period Surveys completed % of patients who did not have enough say in decisions about care and treatment % of patients who had not had the diagnosis discussed with them % of patients who received a care plan Mental Health Council of Australia Report (2004) National 2004 228 completed by consumers, carers, family members and friends 39% 19% 6%
Western Australian Auditor General’s Report 73 consumer case files reviewed Not reported Not reported 78% had a care plan. 23% had consumer involvement 5% of consumers received a copy of their care plan Australasian Clinical Indicator Report 2013 8,025 consumers Not reported Not reported Consumers were involved in 20% of plans Carers were involved in 6% of plans Provision of information to consumers and carers Table : Percentage of mental health consumers receiving insufficient information about medications Study period Surveys completed by consumers, carers and family members or close friends Insufficient information to patient (about condition or treatment) Purpose, benefits and side effects of medicines NOT fully explained Inadequate information given to family and friends Parslow, Lewis & Marsh 1997 10 641 19% Mendoza 2013 561, of 87% received treatment 30% (70% felt they were given the ‘right’ amount or at least ‘some’ information) 45% 54% Mental Health Council of Australia Report 2004 215 41% 76% 60% trial