scholarly journals A re-audit of ECT training and practice

1999 ◽  
Vol 23 (7) ◽  
pp. 419-421 ◽  
Author(s):  
Farida Yousaf ◽  
Martin Lee ◽  
Jose King
Keyword(s):  
Clinical Practice ◽  
Electroconvulsive Therapy ◽  
Royal College ◽  
Current Practice ◽  
Dose Titration ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Information Recording ◽  
Training And Supervision ◽  
New Guidelines

Aims and methodsA re-audit of the current practice of electroconvulsive therapy (ECT) was carried out over a period of five months using the new guidelines produced by the Royal College of Psychiatrists. The areas audited included obtaining consent from the patients, information recording, training and supervision of the junior doctors and the practical aspects of ECT administration, including dose titration.ResultsAn improvement in the training and supervision of junior doctors was seen since the last audit but shortcomings were identified in areas of pre- and post-ECT preparation, information recording and correct use of stimulus-dosing policy.Clinical implicationsRecommendations include the need to improve clinical practice and recording of information.

scholarly journals Electroconvulsive therapy – attitudes and practice in New Zealand

2001 ◽  
Vol 25 (12) ◽  
pp. 467-470 ◽  
Author(s):  
John A. Strachan
Keyword(s):  
Clinical Practice ◽  
New Zealand ◽  
Great Britain ◽  
Electroconvulsive Therapy ◽  
Royal College ◽  
Clinical Implications ◽  
Medical Conditions ◽  
Therapy Attitudes ◽  
Zealand College ◽  
Source Of Information

Aims and MethodThe clinical practice of electroconvulsive therapy (ECT) by New Zealand psychiatrists was surveyed by questionnaire. This paper compares the findings with national and regional surveys conducted in Great Britain, and considers the influence on clinical practice in New Zealand of the Royal College of Psychiatrists' ECT Handbook.ResultsECT has the same level of support from psychiatrists in New Zealand as in Britain, but is less frequently used. Modern brief pulse machines are used by 16 of 19 (84%) services from which data were received. The ECT Handbook was the most nominated source of information on ECT. Most (87%) respondents were aware of at least one set of ECT guidelines. However, these have apparently failed to influence some important aspects of practice. In particular, many medical conditions are still perceived as absolute contraindications.Clinical ImplicationsThe Royal College of Psychiatrists and the Royal Australian and New Zealand College of Psychiatrists need to place even greater emphasis on the importance of training in ECT for both trainees and qualified psychiatrists, and on the promotion of approved guidelines.

scholarly journals Audit of a recently introduced stimulus dosing policy in an electroconvulsive therapy clinic

1999 ◽  
Vol 23 (9) ◽  
pp. 541-543 ◽  
Author(s):  
G. Shaikh ◽  
R. Ireland ◽  
M. McBreen ◽  
R. Ramana
Keyword(s):  
Clinical Practice ◽  
Electroconvulsive Therapy ◽  
Initial Dose ◽  
Dose Adjustment ◽  
Seizure Threshold ◽  
Dose Titration ◽  
Clinical Implications ◽  
Threshold Estimation ◽  
And Training ◽  
Therapy Clinic

Aims and methodTo audit the clinical practice of seizure threshold estimation and subsequent stimulus dose adjustment in the electroconvulsive therapy (ECT) clinic. Case notes of patients who had ECT over a six-month period were audited. Results were discussed at an audit meeting and guidelines and training modified appropriately prior to the second cycle of the audit.ResultsInitial dose titration was poor in the first period, but improved in the second. The majority of patients were insufficiently stimulated after missed seizures in both periods and stimulus doses were not being reduced following prolonged seizures.Clinical implicationsThe audit identified the need for continuing supervision of trainees in addition to clear training and guidelines.

scholarly journals Cognitive therapy training for psychiatrists: impact on individual clinical practice

2004 ◽  
Vol 28 (4) ◽  
pp. 117-119 ◽  
Author(s):  
G. Swift ◽  
I. Durkin ◽  
C. Beuster
Keyword(s):  
Clinical Practice ◽  
Cognitive Therapy ◽  
Response Rate ◽  
Postal Questionnaire ◽  
Clinical Implications ◽  
Previous Survey ◽  
Therapy Training ◽  
Training And Supervision ◽  
Improved Outcomes ◽  
Therapy Sessions

Aims and MethodWe aimed to survey how psychiatrists with in-depth training in cognitive therapy use these skills. A postal questionnaire based on a previous survey was sent to all psychiatrists who are accredited members of the British Association for Behavioural and Cognitive Psychotherapies.ResultsThere was a 94% response rate. Psychiatrists in non-psychotherapy posts used formal cognitive therapy, with an average of 20% of new patients compared with 65% for those in psychotherapy posts, and were less satisfied with the extent to which they were able to use their skills (20%v. 80%). A total of 85% of respondents described themselves as being involved in teaching, training and supervision of cognitive therapy.Clinical ImplicationsUnless psychiatrists are planning on working in specialised psychotherapy posts, they are unlikely to use cognitive therapy training in formal therapy sessions. Further research is needed to determine whether cognitive therapy training for psychiatrists translates into improved outcomes for patients.

scholarly journals Capacity, compliance and electroconvulsive therapy (ECT): the practice of ECT among consultant psychiatrists

2006 ◽  
Vol 30 (1) ◽  
pp. 13-15 ◽  
Author(s):  
Richard Law-Min ◽  
John Patrick Stephens
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Electroconvulsive Therapy ◽  
Best Practice ◽  
Response Rate ◽  
Common Law ◽  
Good Practice ◽  
Legal Framework ◽  
Clinical Implications ◽  
Clinical Vignettes

Aims and MethodThe aim of this study was to seek the views of consultant psychiatrists on the legal framework they would use when considering treatment with electroconvulsive therapy (ECT). A questionnaire, consisting of three clinical vignettes, was sent to 70 consultants in the Wessex rotation (East Dorset/Hampshire region).ResultsA total of 56 questionnaires were returned; a response rate of 80%. Most consultant psychiatrists agree when giving ECT to capacitated and non-consenting patients. However, there was a lack of consensus when dealing with seemingly incapacitated but compliant patients.Clinical ImplicationsMore clarification in this area is needed. Trusts can assist clinicians by devising their own policies based on nationally agreed standards of best practice. The treatment of mentally incapacitated but compliant patients is an area of practice where uncertainty exists. If proceeding under common law in such cases, it is good practice to discuss with relatives/carers and obtain a second opinion from a consultant colleague. The most recent Bournewood judgement and the new Mental Health Bill will have further implications for clinical practice.

scholarly journals Practical training in the administration of ECT

1998 ◽  
Vol 22 (10) ◽  
pp. 633-634
Author(s):  
Richard Barnes ◽  
David Kingsley
Keyword(s):  
Electroconvulsive Therapy ◽  
Training Programme ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Practical Training ◽  
Significant Positive Effect ◽  
Training Device ◽  
Positive Effect ◽  
The Way

Aims and methodElectroconvulsive therapy (ECT) Is widely used In Britain and in most cases is administered by junior doctors. Many are inexperienced in its administration and the variety of machines available makes acquiring experience difficult. This report discusses a unique training programme involving a specially constructed ‘dummy patient’.ResultsThis allows trainees to experience the practical administration of ECT and also learn in detail about the working of the ECT machine and the interpretation of electroencephalograms prior to giving treatment to patients.Clinical implicationsWe believe this training device will have a significant positive effect on the way junior doctors are trained in ECT.

scholarly journals Junior doctors' training in the theory and the practice of electroconvulsive therapy

1997 ◽  
Vol 21 (9) ◽  
pp. 563-565 ◽  
Author(s):  
Richard Duffett ◽  
Paul Lelliott
Keyword(s):  
Electroconvulsive Therapy ◽  
Great Emphasis ◽  
House Officer ◽  
Junior Doctors ◽  
Senior House Officer ◽  
England And Wales ◽  
Training And Supervision ◽  
Effective Administration ◽  
Basic Issue ◽  
Variable Quality

Recent advances in knowledge about effective administration of electroconvulsive therapy (ECT) has placed great emphasis on the importance of good training and supervision of those administering it. The American Psychiatric Associaton requires that doctors be specifically accredited before they are allowed to give ECT. In England and Wales training is much more informal and ECT is often given by junior doctors. Doctors rostered to administer ECT in Wales and in two areas of England were surveyed as part of the College's third audit of ECT. About two-thirds of respondents were at senior house officer level. The training in ECT appeared of variable quality and one-half had not been supervised by an experienced psychiatrist on the first occasion they administered ECT. Responses to exam-type questions revealed that 45% lacked knowledge about one or more basic issue related to effective administration of ECT.

Auditing electroconvulsive therapy

1998 ◽  
Vol 172 (5) ◽  
pp. 401-405 ◽  
Author(s):  
Richard Duffet ◽  
Paul Lelliott
Keyword(s):  
Electroconvulsive Therapy ◽  
Royal College ◽  
Large Scale ◽  
Postal Questionnaire ◽  
Junior Doctors ◽  
East Anglia ◽  
Modest Improvement ◽  
The Past ◽  
North East ◽  
And Training

BackgroundThis is the third large-scale audit in the past 20 years and compares the practice of electroconvulsive therapy (ECT) in England and Wales with the standards derived from the Royal College of Psychiatrists' 2nd ECT handbook.MethodFacilities, equipment, practice, personnel and training were systematically evaluated during visits to all ECT clinics in the former North East Thames and East Anglia regions and Wales. All other English ECT clinics were surveyed with a postal questionnaire. Information was obtained for 184 (84%) of the 220 ECT clinics identified.ResultsAlthough some aspects of ECT administration had improved since the last audit in 1991, overall only one-third of clinics were rated as meeting College standards. Only 16% of responsible consultants attended their ECT clinic weekly and only 6% had sessional time for ECT duties. Fifty-nine per cent of all clinics had machines of the type recommended by the College and 7% were still using machines considered outdated in 1989. Only about one-third of clinics had clear policies to help guide junior doctors to administer ECT effectively.ConclusionsTwenty years of activity by the Royal College of Psychiatrists and three large-scale audits have been associated with only modest improvement in local practice.

scholarly journals High-dose antipsychotic treatment in clinical practice

1999 ◽  
Vol 23 (11) ◽  
pp. 661-664 ◽  
Author(s):  
Philip J. Tyson ◽  
Ann M. Mortimer ◽  
Jason A Wheeler
Keyword(s):  
Clinical Practice ◽  
Antipsychotic Medication ◽  
Royal College ◽  
Treatment Compliance ◽  
Antipsychotic Treatment ◽  
Clinical Implications ◽  
High Dose ◽  
Dose Treatment ◽  
High Dose Treatment ◽  
High Doses

Aims and methodA trust-wide audit of antipsychotic prescription was conducted in order to investigate the prevalence of high-dose treatment in a population with schizophrenia and assess compliance with Royal College of Psychiatrists' guidelines on the use of high doses. Details of antipsychotic medication were recorded and in cases of high-dose treatment compliance with the College's guidelines was assessed.ResultsSixteen out of 361 patients (4%) were receiving high-dose medication. At re-audit this figure fell to four patients (1%). High-dose treatment comprised of a combined depot and oral medication in most cases. There was poor compliance with the College's guidelines.Clinical implicationsThe study stresses the importance of monitoring patients on high-dose antipsychotics, particularly when taken in combination.

scholarly journals Tardive dyskinesia: psychiatrists' knowledge and practice

2011 ◽  
Vol 35 (5) ◽  
pp. 164-167 ◽  
Author(s):  
Chennattucherry John Joseph ◽  
Alan Currie ◽  
Imran Piracha
Keyword(s):  
Clinical Practice ◽  
Tardive Dyskinesia ◽  
Patient Care ◽  
Atypical Antipsychotic ◽  
Current Practice ◽  
Formal Training ◽  
Clinical Implications ◽  
Actual Clinical Practice ◽  
Knowledge And Practice ◽  
Ideal Practice

Aims and methodWe surveyed 180 experienced psychiatrists on their training and practice in diagnosing and managing tardive dyskinesia in the current atypical antipsychotic era.ResultsAbout two-thirds of psychiatrists (n = 124, 69%) responded to the survey. A significant minority had no training in tardive dyskinesia, yet almost everyone recognised the need for formal training in this area. We noted a discrepancy between what respondents believed should be their ideal practice and their reported actual clinical practice. As many as 58% considered that tardive dyskinesia could be a reason for patients to pursue litigation. Many had concerns about prescribing antipsychotics for unlicensed indications, especially for incapacitous patients.Clinical implicationsIt is important to recognise current practice and gaps in training, not only to enhance training and patient care but also to mitigate against the risk of litigation.

scholarly journals Improving electroconvulsive therapy practice through audit

1995 ◽  
Vol 19 (8) ◽  
pp. 480-481 ◽  
Author(s):  
C. Robertson ◽  
T. Wheeldon ◽  
J. M. Eagles ◽  
I. C. Reid
Keyword(s):  
Clinical Practice ◽  
Service Delivery ◽  
Electroconvulsive Therapy ◽  
Royal College ◽  
Marked Improvement ◽  
Psychiatric Service ◽  
Education Programme ◽  
Set Up ◽  
Audit Information

Recent studies have highlighted deficiencies in ECT service delivery. This audit was set up to monitor and improve the ECT administered in a large psychiatric service. In the first phase of the audit Information was collected regarding stimulus adjustment in response to brief seizures. This highlighted inconsistencies In clinical practice and an education programme was instigated to correct these deficiencies and to bring practice into line with the Royal College of Psychiatrists guidelines. A repeat audit was performed and a marked improvement in the quality of stimulus adjustment was shown.

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