H51 Project 564: monitoring electrocardiogram (ECG) in patients on antipsychotic medication admitted to psychiatric ward during admission period in october 2017 (re-audit of project 2057)

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Abstract

Background

Our multi- disciplinary team offer assessment and treatment for a wide range of mental health problems and neuropsychiatric disorders such as Huntington’s disease (HD). Although HD is a disease of the central nervous system, mortality surveys indicate that heart disease is a leading cause of death.1 The previous audit about the ECG monitoring was conducted in July 2013 (Project 2057). The monitoring of ECG abnormalities of inpatients involves an ECG which expected to be performed at admission, and repeated when patients are commenced on high-dose antipsychotics. The QTc is considered the most appropriate measure for ventricular repolarization. Interpretation of case reports of arrhythmia and sudden death in patients receiving these drugs is complicated because psychiatric patients are known to be at a high risk of cardiovascular death.2 Researchers assessed ECGs from a large cohort of patients with early HD found increased prevalence in cardiac conduction abnormalities and bradycardia. These results suggest caution is indicated in using medications that may have additive cardiac toxicity.3

Standards

There are currently no specific standards for monitoring ECGs in patients on antipsychotics. However, we used the same standards from the previous Audit which included; the trust guidelines for physical assessment for patients,4 The Royal College of Psychiatrists (RCPsych Consensus statement on high-dose antipsychotic medication5 and NICE guidance for Schizophrenia March 2009.6

Methodology

Sample:

Methodology

Search Strategy:

Conclusion and recommendation

Doctors should be made aware and reminded that ECGs are important in monitoring for any cardiac abnormality which could be detrimental in patients taking antipsychotics, and patients at high risk of developing cardiovascular problems such as Huntington’s disease.

Abbreviation

EGG: Electrocardiogram

Abbreviation

HD: Huntington’s disease

Abbreviation

Amigos: Patient’s electronic data

Abbreviation

QT interval: the time from the onset of ventricular depolarization to completion of repolarization

Abbreviation

QTc: QT interval with a correction for heart rate

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