Presentation on theme: "Standards of Electroconvulsive Therapy (ECT) Services at Zomba Mental Hospital (ZMH) Michael M. M. Udedi."— Presentation transcript:
Standards of Electroconvulsive Therapy (ECT) Services at Zomba Mental Hospital (ZMH) Michael M. M. Udedi
Introduction The hospital acquired a donation of 2 ECT machines (Mecta SR models) from Scotland and anaesthetic equipment through the Ministry of Health in 2007. Modiﬁed ECT was introduced at Zomba Mental Hospital in the ﬁrst week of September in 2007. Selis, Kauye & Leentjens, (2008:140) suggested that modiﬁcation of ECT approaching western standards was possible with clear ECT guidelines, consent procedures, and adequate monitoring of effect and side effects. It is against this background that there was need to conduct ECT audit at ZMH in order to assess the provision of care
Objective To identify the quality of care in terms of ECT provision to patients at Zomba Mental Hospital
ZMH - SET STANDARDS FOR ECT The ECT should be done under anaesthesia (90% of cases) Files for the patients undergoing ECT should include ECT forms (95% of cases) The indication of ECT should be written down (95% of cases) The consent form should completed appropriately (90% of cases) Physical examination should be done and recorded within a week before ECT (95% of cases)
ZMH - SET STANDARDS FOR ECT Vital signs should be checked before and after the ECT and recorded (95% of cases) Each ECT, dose, seizure length and anaesthetic given should be recorded (90% of cases) Every patient receiving ECT should be reviewed and review recorded after every two ECT sessions before further ECT session is conducted (Clinical condition, side effects and consent status) [90% of cases]
Design This was a retrospective case file audit study It looked at previous patients records who underwent ECT and also the administration of ECT itself in an attempt to determine the quality of care in terms of patients.
Sampling & sample size Patients’ records for this study were randomly selected using a systematic sampling technique A sample size of 30 case files belonging to the patients who were previously admitted at the hospital between August 2008 and December 2008 who underwent ECT 60 patients underwent ECT during the study period thus in this case every 2 nd case file of the population was selected
Inclusion Criteria Cases included in the audit were all the case files for psychiatric patients registered with ZMH from August 2008 to December 2008. The patients selected were based on the fact that they underwent ECT.
Data Collection Data was collected using specially designed form which included the following: Demographics, Diagnosis Indication for ECT Consent Physical Examination and Vital signs check Procedure Reviews after ECT
General Results During the study period, 60 patients under-went ECT but 30 were sampled - 6 men and 24 women. Their ages ranged from 16 to 54 years. 10 patients were diagnosed with a bipolar disorder (33%), 5 with a depression (17%), 4 with a mania (13%), 2 with a postpartum psychosis (7%), 3 with a schizophrenia (10%) and 6 with a schizoaffective disorder (20%). The total number of sessions varied from 4 to 6. The length of the clinically observed convulsions varied from 11 to 160 seconds and the dose ranged from 225 to 400mc.
DISCUSSION All patients underwent modified ECT Almost all files had consent forms although most of the consent forms were not completed appropriately ECT form did not cater properly for all pre ECT vital signs and post ECT vital signs Consent form was in English language ECT information sheet was in English language and was not available in all patient files 37% of patients did not undergo physical examination prior to ECT Most of the indications written on the ECT form were also the diagnoses
RECOMMENDATIONS FOR CHANGE Consent forms to be completed appropriately ECT form to be reviewed to cater properly for all pre ECT vitals and post ECT vitals Consent form to be translated into vernacular language ECT information sheet to be translated into vernacular language and be put in patient files ECT protocol to be pasted in all wards and also to be placed in procedure manuals
Cont’d The indication written on the ECT form should be specific i.e. Emergency life saving, too distressed to await response to medication, severe psychomotor retardation/agitation, suicidal ideation, patient preference, medication resistance, previous good response
RECOMMENDATIONS FOR FURTHER AUDIT Re-audit of the ECT standards Dosing and seizures Number of sessions per week Average effective ECT sessions Side effects of modified ECT
Conclusion The results revealed the gaps in the provision of ECT services in relation to the required standards. The results also indicated commitment to satisfy the introduced standards Efforts to improve other treatment standards should be undertaken i.e. consent & indication.
Acknowledgements Dr Kauye for the support Dr Stewart for the guidance and support Records Clerks for their assistance in locating the files Colleagues in Clinical Psychiatry Department for moral support during the data collection