Compliance with ECT NICE guidance by the John Connolly ECT clinic: January 2010 - July 2010

To review current practice at the John Connolly Wing ECT clinic and to explore compliance with NICE ECT guidance. Standards used included the ECT TA59 guidelines of 2003 with the updated depression guidance CG90 of 2009. To recommend a programme of action to the Trust which would ensure that clinical practice and service delivery within the Trust complies with NICE guidance.

A retrospective baseline Trust wide audit was conducted between the period of January 2010 to July 2010 inclusive. Cases were identified using ECT clinic record then computer Rio notes explored for evidence of compliance with NICE guidelines as set out in the audit standards. All data was extracted from the case notes on the Rio system. An audit tool was completed for each case. The data recorded on the audit tool was explored and entered onto an Excel spreadsheet for analysis.

A total of 14 patients were identified. Of these, 6 were male and 8 were female. They comprised of 8 inpatients and 6 outpatients. The majority of patients had a diagnosis a severe depressive episode. 13 patients received bilateral ECT. In 1 case the first 3 sessions were unilateral and the rest were bilateral due to patient choice. 9 patients consented to ECT; 5 lacked capacity to consent and 1 of those was treated under Section 62 of the Mental Health Act. The number of treatments ranged from 0-15 with an average number of 7. This included 1 patient who did not receive ECT at all due to concerns raised by anaesthetist once at the ECT clinic. Reasons for stopping ECT included a response being achieved in 5 patients; anaesthetic risk in 3; withdrawal of consent in 2; T6 no longer valid in 1; no reason documented in 3 patients. Compliance with NICE guidelines was particularly good regarding the indications for ECT. An adequate trial of treatment was evidenced prior to consideration of ECT. Documentation of the exploration of the risk to benefit ratio both amongst the team and with the patient was poor. Assessment of the patient after each ECT and on-going cognitive assessment was poor.

This audit highlights the need for sound documentation of our practice. It also stresses the need for further clarity regarding the roles and responsibilities of the RMO and their team and the ECT team.

An ECT Care Pathway document has been produced to improve compliance with NICE guidance and improve documentation of practice. This document has been introduced for use in the Trust. We plan to re-audit for improvement in compliance.