Summary

• The RCPsych advises ECGs on newly admitted patients.

• ECGs were not performed within the recommended timeframe. This negatively impacted patient safety.

• Introduction of a three times weekly ‘board round’ check increased compliance with the standard.

• ECG machine availability is recognized as one factor in failing to adhere to the 48 h standard.

Background The RCPsych published integrated physical health guidelines for newly admitted inpatients, outlining the need to ‘arrange physical health checks within 48 h’ including ECGs to exclude cardiac side effects of psychotropic medication.¹

Method A baseline audit conducted in December 2016 showed that only a small proportion (33%) of patients had an ECG performed within 48 hours of admission. A 3× weekly ‘Physical Health Board Round’ was introduced on three wards to see if this improved compliance. A re-audit was undertaken in May 2017 to assess if there had been any improvement in the frequency of performance and documentation of ECGs.

Results After the intervention, ECGs were performed within 48 hours of admission in 45 cases and not in 68 cases. The most common reason an ECG was not performed was that the patient declined (n=23). The compliance therefore increased to 45/90=50%

Conclusion Implementing 3× weekly physical health ‘board round’ improves ECG compliance. 50% of patients are still not receiving ECGs, some with no explanation. Further work should be undertaken to explore this deficit. Investment has been made into further ECG machines for the hospital as a result of this study.

Reference

1. Royal College of Psychiatrists. Integrated physical health pathway 2014. Available at https://www.rcpsych.ac.uk/pdf/NAS%20Integrated%20Physical%20Health%20Pathway%20Dec%2012.pdf [accessed: 25/10/17].