Audit: Medical Work-up before prescribing Antipsychotics, by Psychiatry Trainees in Malta.

Authors: Dr. Steve Sammut-Alessi & Dr. Giovanni Grech

Aims: The audit aims to assess whether psychiatric trainees in Malta follow guidelines with regards to baseline investigations prior to starting antipsychotic medication.

Method: The current NICE guidelines and Maudsley guidelines were reviewed and a questionnaire was compiled listing the investigations recommended to be taken prior to commencement of an antipsychotic medication. The questionnaire was distributed by hand to all trainees working within the  national health service in Malta over the past month.  The questionnaire also assessed the level of training as well as the MRCPsych status.

Results: Thirteen trainees out of a total of sixteen trainees, excluding the authors, answered the questionnaire. Of these, seven (53.8%) were BSTs while six (46.2%) were HSTs. Seven (53.8%) have achieved their MRCPsych Part 1 examination while only two trainees (15.4%) completed their membership examinations. Blood pressure and pulse measurements were always/frequently taken in 46.1% and 38.4% respectively, while they were sometimes taken in 46.1% each. Other parameters were rarely/never taken; waist circumference (76.9%), weight (61.5%), BMI (53.8%). Investigations that were always/frequently taken included: ECG (84.6%), CBC (76.9%), U&E (76.9%), LFT (76.9%), FBG (69.2%), Lipid Profile (69.2%), an TFTs in 69.2%. HbAic was sometimes/rarely taken (61.5%). On the other hand prolactin and CK was rarely/never taken (53.8%). The assessment of physical activity, diet and nutritional status was done in 69.2%, 46.2% and 30.8% respectively, while 30.8% of participants did not assess these parameters.

Conclusions: Starting antipsychotic medications is commonly done by psychiatric trainees working within the national mental health service in Malta. It is evident from this research that better adherence to guidelines is necessary to avoid undue adverse consequences. Consequently we intend to circulate these guidelines to improve our practice.