Quality indicators of psychotropic prescribing to people with dementia in aged psychiatry inpatient units.

OBJECTIVES: To develop indicators of safe psychotropic prescribing practices for people with dementia and to test them in a convenience sample of six aged mental health services in Victoria, Australia. METHOD: The clinical records of 115 acute inpatients were checked by four trained auditors against indicators derived from three Australian health care quality and safety standards or guidelines. Indicators addressed psychotropic medication history taking; the prescribing of regular and 'as needed' psychotropics; the documentation of psychotropic adverse reactions, and discharge medication plans. RESULTS: The most problematic areas concerned the gathering of information about patients' psychotropic prescribing histories at the point of entry to the ward and, later, the handing over on discharge of information concerning newly prescribed treatments and the reasons for ceasing medications, including adverse reactions. There were wide variations between services. CONCLUSION: The indicators, while drawn from current Australian guidelines, were entirely consistent with current prescribing frameworks and provide useful measures of prescribing practice for use in benchmarking and other quality improvement activities.

Continuation-maintenance electroconvulsive therapy: quality standards in 3 Australian aged psychiatry services.

OBJECTIVE: To check if experienced psychiatrists in Victoria, Australia, observed the standards outlined by the American Psychiatric Association and the Royal College of Psychiatrists regarding the administration and monitoring of continuation-maintenance electroconvulsive therapy (ECT). METHODS: A retrospective chart review of 60 consecutive patients given continuation-maintenance ECT in 3 Victorian public aged psychiatry services. RESULTS: Practice guidelines were often not observed concerning documentation of treatment plans, mental state reviews and patients' and carers' viewpoints. CONCLUSIONS: Continuation-maintenance ECT proved highly effective in this clinical sample. Our audit identifies areas for improvement in clinical practice. It will be helpful to have a simple checklist of treatment plans, rating scale scores, and discussions with patients and carers that clinicians can complete at regular intervals.

The effectiveness of continuation-maintenance ECT in reducing depressed older patients' hospital re-admissions.

BACKGROUND: We report on the outcomes in aged patients with severe, treatment-resistant depression or psychosis who were given ongoing outpatient continuation-maintenance ECT of varying duration to prevent remission and relapse following a successful course of acute ECT. METHODS: A retrospective chart review of 58 consecutive patients of three Australian aged psychiatry services comparing the number and length of psychiatric admissions before and after the start of continuation-maintenance ECT. RESULTS: Four patients had only one treatment and two received over 50 (mean 14.7). Five were still enrolled in a maintenance program two years later. In the two years after continuation-maintenance ECT started, admissions fell by 53% in number and 79% in duration compared with the previous two years. Within the actual treatment period which varied from one patient to another, admissions fell by 90% in number and 97% in duration compared with the same period beforehand. CONCLUSION: A treatment effect cannot be proven but the severity and chronicity of patients' conditions make placebo effects and spontaneous remission unlikely. Randomised, controlled trials are almost impossible in this setting and so carefully conducted reviews and case-control studies are still of value. Our findings suggest that continuation-maintenance ECT is effective in carefully selected patients at high risk of relapse.