‘Real time’ monitoring of antipsychotic prescribing in patients with dementia: a study using the Clinical Record Interactive Search (CRIS) platform to enhance safer prescribing

Abstract

BackgroundThe use of antipsychotic drugs in dementia has been reported to be associated with increased risk of cerebrovascular events and mortality. There is an international drive to reduce the use of these agents in patients with dementia and to improve the safety of prescribing and monitoring in this area.ObjectivesThe aim of this project was to use enhanced automated regular feedback of information from electronic health records to improve the quality of antipsychotic prescribing and monitoring in people with dementia.MethodsThe South London and Maudsley NHS Foundation Trust (SLaM) incorporated antipsychotic monitoring forms into its electronic health records. The SLaM Clinical Record Interactive Search (CRIS) platform provides researcher access to de-identified health records, and natural language processing is used in CRIS to derive structured data from unstructured free text, including recorded diagnoses and medication. Algorithms were thus developed to ascertain patients with dementia receiving antipsychotic treatment and to determine whether monitoring forms had been completed. We used two improvement plan-do-study-act cycles to improve the accuracy of the algorithm for automated evaluation and provided monthly feedback on team performance.ResultsA steady increase in antipsychotic monitoring form completion was observed across the study period. The percentage of our sample with a completed antipsychotic monitoring form more than doubled from October 2017 (22%) to January 2019 (58%).Conclusion‘Real time’ monitoring and regular feedback to teams offer a time-effective approach, complementary to standard audit methods, to enhance the safer prescribing of high risk drugs.

Psychosis Early Intervention Across the Life Span: A Service Perspective

“…The Trust’s Clinical Record Interactive Search (CRIS) interface (Stewart et al, 2009 ) was used to extract de-identified information from the electronic clinical record system. CRIS is a well-established system and has been used for multiple research studies (Colling et al, 2020 ; Oduola et al, 2019 ; Roberts et al, 2016 ). Data was extracted on 2nd December 2019.…”

Antipsychotic monitoring in dementia: quality of completion of antipsychotic monitoring forms in an older adult mental health service

“…A strength of this project was that we were able to collect data from all forms completed over 2 years rather than taking a smaller, random sample. A limitation is that an earlier study 5 carried out by the department estimated that 40% of patients who were prescribed antipsychotics for BPSD did not have a completed form, so we were unable to capture and assess the monitoring of antipsychotic medication in these people. A further limitation is that information was gathered exclusively from the forms for this study, and we did not attempt a full case-note review for clarification.…”

“…Following this project, monitoring form completion more than doubled (from 21.6% in October 2017 to 58.0% in January 2019). 5 However, for the forms to fulfil their role, the quality of information recorded needs to be high as well as the form completion rate. Also, since the introduction of the forms, the rate of antipsychotic prescribing in those with dementia in SLaM has remained static.…”