An audit into the physical health monitoring of patients who are prescribed antipsychotics in HMP Birmingham

AimsTo assess the compliance of physical health monitoring with NICE and Maudsley prescribing guidelines for those patients prescribed antipsychotics in HMP Birmingham. To assess secondary objectives including who prescribed the antipsychotics (GP vs psychiatrist), the indication and diagnosis they are prescribed for (licensed or otherwise) and which antipsychotics were usually prescribed.BackgroundPatients with psychosis or schizophrenia have a reduced life expectancy of 15-20 years when compared to the general population. The physical health effects of the medication prescribed for these conditions play a large role in this. Physical health monitoring and appropriate intervention is vital to reduce the discrepancy in life expectancy and improve the quality of life of these patients.MethodNotes of 105 patients in total at HMP Birmingham were reviewed to assess whether the primary outcomes of weight, waist circumference, physical observations, blood tests, medical systems review and education/lifestyle advice were done at the correct times. Secondary objectives of which antipsychotics were prescribed, the profession of the prescriber and the indication for the medications (or diagnosis) were also audited.ResultAntipsychotics were initiated by both GP's and psychiatrists. Appropriately, there were no prescriptions for clozapine. Olanzapine and quetiapine were the most common antipsychotics prescribed. Not all medications were prescribed for licensed indications and some lacked documentation of both a mental health diagnosis and indications in terms of symptoms. Average BMI of patients was overweight, with BMI ranging as high as 45. The pre-prescription, 12 weekly and annual physical health checks had poor compliance. Those that were completed in line with NICE and Maudsley guidelines were done so by coincidence at the time of diabetic reviews.ConclusionThe physical health monitoring of patients on antipsychotics in HMP Birmingham is not currently compliant with clinical guidelines. There needs to be improved systems in place for the monitoring of physical health both before prescriptions are initiated and after at the NICE recommended intervals. Amongst other actions, improved computer reminders and training of existing and new team members will be done. The monitoring requirements will be re-audited in 6 months following immediate implementation of the recommendations outlined below.

Smart Software Can Increase Sit–Stand Desk Transitions During Active Computer Use

The objective use of table top adjustable sit–stand desks has yet to be determined, due to the lack of an effective digital evaluation method. The objective of this study was to evaluate the impact of computer prompt software on table top sit–stand desks to determine if there was a difference in the frequency of desk position changes. This five month, pre-post pilot study on 47 university staff members used a novel USB accelerometer sensor and computer software reminders to continuously record and prompt increases in desk usage to promote physical activity at the workstation. During the baseline phase (3 months), desk usage data were continuously recorded for all workers. Following the baseline, the results from a two-month intervention of personalized computer reminders doubled the number of desk position changes per work day from 1 desk position change every 2 work days to 1 change every work day. Furthermore, those who changed desk positions once or twice a day increased from 4% to 36% from baseline to intervention. Overall, the intervention was encouraging, but longer intervention studies are warranted to determine if the desk usage behavior change can be improved and sustained for years and whether that change results in health gains.