G97 RE-AUDIT OF MANAGEMENT OF ADHD WITH METHYLPHENIDATE BASED ON NICE GUIDANCE

S. Banerjee, S. Venables.East Kent Hospitals NHS Trust, Canterbury Kent, UK

Background: Authors conducted a multidisciplinary interface audit across East Kent in 2002/03. The audit demonstrated that practices met some of the standards but deficiencies were identified. There was also variation in practice across the region. The results of this audit were presented in October 2003 and a time bound action plan was agreed.

Aims and Objective: To re-audit the use of methylphenidate in children with ADHD and complete the audit cycle loop six months after all the agreed actions were in place.

Method: A retrospective case notes review of children diagnosed with ADHD between 1 January 2004 and 30 June 2004 and subsequently started on short/long acting methylphenidate.

Settings: Five specialist ADHD clinics, other clinics at CAMHS sites and community paediatric clinics across East Kent.

Results: A total of 58 notes were audited. Re-audit showed an increase in the use of Conners’ rating scales to 91.38% v 66% in the previous audit. More children had their pulse and blood pressure recorded before start of medication (84% v 51%). “Trial-off” medication was considered in 82% v 16% in the previous audit. There has been no significant change in the joint care with GPs (3% v 2%). Schools, parents, and GPs received written information respectively in 71% v 60%, 69% v 64%, and 93% v 89% cases at start of methylphenidate and in 57% v 53%, 59% v 57%, and 69% v 75% cases about the most recent visit.

Conclusions: This re-audit showed improvements in most areas identified in the previous audit. Shared care arrangements with GPs continue to be an issue and work is ongoing. A new time limited action plan is being developed. This audit cycle demonstrates multidisciplinary working between paediatricians, child psychiatrists, nurses and therapists, carer involvement, …