Audit and Re-Audit: Improving Standardised Admission Blood Tests Adherence for Psychiatric Intensive Care Unit (PICU) Patients

Aims1.To evaluate current adherence with the Royal College of Psychiatrists guidance “Standards for Inpatient Mental Health Services”: Were the blood tests carried out within 24-hours of admission?2.We standardised the blood test parameters that are required following admission to our PICU ward and measured if all relevant blood tests* were completed during admission.3.Re-audit after implementation of a standardised policy.*(Full blood count, urea and electrolytes, liver function tests and lipid profile, CRP, thyroid function tests, vitamin B12, folate, prolactin, vitamin D, calcium and HbA1c%).MethodsFirst cycle is an audit of electronic patient records for all admissions to the PICU ward in a two-month period by using an audit proforma to capture information to answer the questions above.After implementing a standardised guideline for PICU, second cycle was conducted over a two-month period for the re-audit.ResultsIn the first cycle, a total of 20 patient records were audited. 30% had bloods taken within 24 hours of admission to PICU. 10% of patients had bloods taken on their previous ward. 40% of patients declined/unsafe, and 20% were not done in the timeframe.69% of patients directly admitted to PICU had all the relevant admission blood tests completed and 23% had some of the blood tests done. These numbers were lower for the patients transferred to PICU from other wards.In the second cycle, a total of 16 patient records were audited. There was an improvement in number of patients having bloods done within 24 hours of admission with only 6% not done in the timeframe.Of the patients directly admitted to PICU, all the consenting patients (89%) had all the standardised blood tests. These figures remained lower for those patients transferred from other wards without an indication to retest the bloods.ConclusionThe standardised guideline for PICU that was implemented after the first cycle consisted of a pre-filled blood test request form which included all relevant parameters detailed above.This had a positive impact with a significant percentage increase in the total number of patients directly admitted to PICU having all relevant admission blood tests completed at re-audit (77% to 100%).There was also a significant percentage increase (80% to 94%) of bloods taken within 24 hours of admission to PICU.The next step will be to implement these pre-filled forms across all wards in the KMPT trust.