Table 42 'Monitoring Side Effect of Anti-Psychotic Treatment'

PSI 42: Monitoring Side effects of Anti-psychotic treatment
Review of a PSI from the Danish National Indicator Project (NIP) (56-58)
Dimension Description
Description of Specific
Aspects of Patient Safety
Antipsychotic treatment often has side effects with a substantial
qualitative and quantitative harmful impact. Thus assessment of weight
gaining, sexuality, sedation and neurological symptoms must be
assessed in order to give adequate treatment and obtain compliance.
Thus is an adequate measure of patient safety.
Aim of the PSI This PSI is intended to survey the practice screening for side effects in
schizophrenic patients receiving anti-psychotic treatment.
Level of Determination of
Patient Safety
Safety is assessed at the aggregated patient level.
Source(s) Originally a PSI of NIP in Denmark. This PSI is part of an indicator set
of nine indicators for surveillance of the quality of care provide for all
Danish inpatients with schizophrenia (58).
Extent of Clinically
Testing
The Danish National Indicator Project aims at documenting and
improving the quality of care, the project was established in 2000 as a
nationwide mandatory multidisciplinary quality improvement project.
From 2000 to 2002, disease-specific clinical indicators and standards
were developed for six diseases: stroke, hip fracture, schizophrenia,
acute gastrointestinal surgery, heart failure, and lung cancer).
Indicators and standards have been implemented in all clinical units
and departments in Denmark treating patients with the six diseases.
Results feedback is monthly, and yearly regional and national audit
processes are organised to explain the results and to prepare
implementation of improvements. All results are published in order to
inform the public, and to give patients and relatives the opportunity to
make informed choices (57).
This process PSI of NIP is bases on extensive literature studies and
described in detail (61) in agreement with the National Danish
Guidelines for Schizophrenia (62).
The NIP expert panel concluded that this PSI generally performs well.
Evidence of Clinically use
of Standards
Side effects are monitored for 100% of all patients receiving
antipsychotic treatment.
PSI category Diagnose Specific as well as other Specific PSIs.
Data definitions All patients with a primary or secondary diagnosis of schizophrenia;
any ICD-10 F.20 diagnosis receiving antipsychotic treatment.
Numerator Description Assessed side effects of antipsychotic treatment.
Denominator Description Patients discharges from hospital with an ICD-10 diagnosis of any F20
– diagnose (F20.0-F20.99)
SImPatIE WP4 – Catalogue of Patients Safety Indicators
106
Data Source Patient records.
Identifying the
institutional context
The consequences of side effects of antipsychotic treatment in
schizophrenic patients make this PSI important in quality improvement
policies.
Care Setting The PSI applies for quality health care.
Professionals Responsible
for Health Care
Authorised health care workers.
Lowest Level of Health
Care Delivery Addressed
Individual clinical department.
Allowance for Patient
Factors
No risk adjustment described.
Stratification by
Vulnerable Populations
Stratification according to :
− Age: 1) Patients ≥ 18 years and 2) patients < 18 years
− Psychopathological status: 1) the patient has been diagnosed
within the last 12 month (incident) or 2) the patient was diagnosed
more than 12 month ago (prevalent)
− Treatment status: 1) the patient has been in treatment (ambulatory
care or inpatient) for the previous year or 2) the patient is
discharged from in-patient/out-patient treatment
− Type of side effects:
• Neurological side effects
• Sedation
• Gaining weight
• Sexual side effects
• Fasting blood sugar
Standard of Comparison No specific time standards given, but yearly comparison has shown to
be good.
Scoring NIP has software for scoring the PSI. Cumulated scores are subjected
to auditing.
On the basis of the first experience with NIP, a number of requirements
has been specified for a forthcoming second generation of clinical
database system has been described. The requirements regard:
coordination, rational management and experience-based development
of IT systems for the clinical databases and integration with present
and forthcoming systems including electronic patient record systems
(63).