Book contents
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
87 - Electroconvulsive therapy: facilities
from VII - Treatment
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
Summary
Setting
This audit is of particular relevance to old age and general adult psychiatric services.
Background
Despite the publication by the Royal College of Psychiatrists (1995) of detailed standards for the provision of electroconvulsive therapy (ECT), a three-cycle audit (Duffett & Lelliott, 1998) highlighted deficiencies in equipment and training and supervision of junior psychiatrists.
Standards
The standards were obtained from the ECT Accreditation Service (Royal College of Psychiatrists, 2003):
ᐅ The ECT clinic should comprise a minimum of three rooms, be clean, comfortable, welcoming, of adequate size, easily accessible and have toilet facilities.
ᐅ The clinic should have a small fridge and secure drug storage cupboard.
ᐅ Protocols for anaphylaxis, malignant hypertension and cardiac arrest should be displayed.
ᐅ Physical assessment of patients before ECT should include as a minimum:
▹ a recent complete medical history and full examination
▹ details of any previous anaesthetics or operations
▹ a full list of the patient's prescribed drugs and allergies.
ᐅ The equipment should include:
▹ recording ECT machine and patient trolleys
▹ oxygen intermittent positive pressure ventilation, with one face mask per patient
▹ cardiac arrest tray, suction machine and intravenous infusion sets
▹ pulse oximeter, capnograph, electrocardiographic monitor, defibrillator, laryngoscope and blood glucose monitor.
ᐅ Drugs available in the clinic should include:
▹ anaesthetic induction agent (propofol, thiopentone)
▹ muscle relaxant (suxamethonium)
▹ atropine, glycopyrolate, midazolam, naltrexone and dantrolene.
ᐅ Staff in clinic areas should consist of:
▹ a senior nurse with special responsibility for ECT
▹ a trained nurse in each of the treatment rooms and the recovery area
▹ an untrained staff member in the waiting area
▹ one person competent in cardiopulmonary resuscitation and one advanced life support provider
▹ a named consultant psychiatrist (ECT lead) with a dedicated ECT session
▹ a named lead clinician for anaesthesia for ECT and a trained assistant present during treatment
▹ doctors administering ECT, trained in the theoretical ▹ basis of ECT and familiar with local policy and procedure and clinic layout, and directly supervised at least three times before they perform unsupervised administration.
ᐅ Policies and procedures should be available with guidance on what settings to use to induce seizures, what to do in the absence of a seizure and when to terminate a prolonged seizure.
- Type
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- Information
- 101 Recipes for Audit in Psychiatry , pp. 205 - 206Publisher: Royal College of PsychiatristsPrint publication year: 2011