Aims The aims of this audit were to assess compliance with the standards set out in the NICE guidelines with respect to assessment, diagnosis and management of children with Attention Deficit Hyperactivity Disorder (ADHD); and to assess compliance with the local ‘ADHD clinic review proforma’.
Method 20 patients who were coded with an ADHD diagnosis and under the care of the local community paediatric team, were randomly selected in October 2016. Each patient’s notes were reviewed in regards to specific aspects of the national guidelines. The use of the local ‘ADHD clinic review’ proforma was assessed in follow-up patients.
Results All patients had diagnostic questionnaires completed by both school and parents; but only 50% had questionnaires completed by the child themselves. Additional written information was rarely provided by school (13%) and only a quarter of children had an educational psychology report. In relation to premedication assessment, the child’s weight and height were generally documented (88%), but not consistently plotted on a centile chart. Cardiac family history was documented in 75% of cases. However, cardiac symptoms were only recorded in 25% of cases, and cardiac examination completed in 38% of cases. Blood pressure was often taken (62%), but rarely plotted on a centile chart. All children identified as being at higher risk of cardiac problems did get an ECG prior to commencing medication. The local ‘ADHD clinic review’ proforma was generally utilised (82%). Further areas for improvement include: plotting height, weight and blood pressure on centile charts. All changes in medication were clear, and informed consent obtained. The ‘voice of the child’ was only documented in 28% of cases.
Conclusion This audit has demonstrated that generally local compliance with the the NICE guidelines regarding diagnosis and pre-medication assessment of children with ADHD was good. However, several areas for improvement have been identified, including improvement around pre-medication assessment, and ensuring the ‘voice of the child’ is documented. In view of this, a new ‘Pre-Medication Assessment’ proforma was created, and the results of the audit presented to the local ADHD team, with a plan to re-audit following these interventions.
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