Physical Health & Examination Policy · This policy sets minimum standards for the assessment and...

Physical Health & Examination

Policy

Policy Reference No. KMPT.CliG.026.03 Replacing document Reviewed policy August 2009/ ClinGov102.01 Target Audience Trust wide Author Chief Pharmacist Group responsible for development of this policy

Clinical Governance Patient Safety Group

Status Approved Version No. 3.0 Authorised/Ratified By Clinical Governance Patient Safety Group Authorised/Ratified On 27 October 2009 Date of Implementation 30/10/09 Review Date October 2012 Distribution Date 30/10/09 Number of pages 23 Contact point for queries [email protected] Copyright Kent and Medway NHS and Social Care Partnership Trust 2009

DOCUMENT TRACKING SHEET

PHYSICAL HEALTH & EXAMINATION POLICY

Version Status Date Issued/approved by Comments V0.1 Draft 01.04.07 Clinical and Cost Effectiveness

Committee

V1.0 Approved 01.04.07 Clinical and Cost Effectiveness Committee

V2.0 10.08.07 Policy Manager Formatting V2.1 Approved 06.11.08 Policy Manager Formatting/ Update V2.2 2.08.09 Reviewed Duties, clarified Monitoring

section, refocused V3.0 Approved 27/10/09 Trustwide Clinical Governance

Patient Safety Group

REFERENCES

‘The Mental Capacity Act Deprivation of Liberty safeguards’. DH website list of resources and links. Valuing People Now: A New Three-year Strategy for Learning Disabilities. (2009) Refocusing the Care Programme Approach: Policy and Positive Practice. (2008) Choosing Health: Supporting the physical health needs of people with severe mental illness - commissioning framework. (2006)

From values to action: The Chief Nursing Officer’s review of mental health nursing. (2006) Mental Health Policy Implementation Guide - Acute In-patient Care Provision. (2002) University of Manchester. (2006). Avoidable Deaths Five year report of the national confidential inquiry into suicide and homicide by people with mental illness. University of Manchester. (2008). Independent Homicide Investigations: The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness University of Manchester. (2009). National Confidential Inquiry into Suicide and Homicide by People with Mental Illness: Annual Report: England and Wales. University of Manchester. (2010). National Confidential Inquiry into Suicide and Homicide by People with Mental Illness: Annual Report: England and Wales. Disability Rights Commission. (2007). Equal treatment: Closing the Gap – One Year on. Report of the reconvened formal inquiry panel of the DRC’s formal investigation into the inequalities in physical health experienced by people with mental health problems and learning disabilities. London: DRC. Available at: http://www.leeds.ac.uk Morgan, S. (2009). Clinical Risk Management: A Clinical Tool and Practitioner Manual. London: The Sainsbury Centre for Medical Health. National Institute for Clinical Excellence (NICE). (2007). CG45. Antenatal and postnatal mental health: The NICE guideline on clinical management and service guidance. London: NICE. Available at: www.nice.org.uk National Institute for Health and Clinical Excellence (NICE). CG16. Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. London: NICE. Available at: www.nice.org.uk Patient Safety First. ‘How to Reduce Harm from Deterioration’. Patient Safety First website page. Available at: www.patientsafetyfirst.nhs.uk Royal College of Psychiatrists. (2010). Self-harm, suicide and risk: a summary. Position statement. London: RCP. Available at: www.rcpsych.ac.uk Sainsbury Centre for Mental Health. (2009). Looking ahead: The next 25 years in mental health. London: Sainsbury Centre for Mental Health. Available at: www.centreformentalhealth.org.uk

RELATED POLICIES/PROCEDURES/PROTOCOLS/FORMS/LEAFLETS

Reference CPA Policy KMPT.CliG.001.01 Resuscitation Policy KMPT.CliG.010.02 Standards for Record Keeping policy KMPT.InfG.035.02

http://www.leeds.ac.uk/disability-studies/archiveuk/DRC/closing_the_gap_fi.pdf

http://www.nice.org.uk/

http://www.nice.org.uk/

http://www.patientsafetyfirst.nhs.uk/

http://www.rcpsych.ac.uk/

http://www.centreformentalhealth.org.uk/

CONTENTS

EXECUTIVE SUMMARY ...................................................................................................1

1 INTRODUCTION AND PURPOSE .............................................................................2

2 OBJECTIVE ...............................................................................................................2

3 SCOPE AND RESPONSIBILITY................................................................................2

4 DUTIES AND RESPONSIBILITIES............................................................................2

5 REQUIREMENTS FOR PHYSICAL ASSESSMENT OF INPATIENT SERVICE

USERS ......................................................................................................................3

6 FOLLOW UP OF PHYSICAL SYMPTOMS................................................................4

7 ON-GOING PHYSICAL HEALTH CARE OF ALL PATIENTS...................................4

8 TRAINING AND AWARENESS .................................................................................5

9 STAKEHOLDER INVOLVEMENT..............................................................................5

10 RECORD KEEPING................................................................................................5

11 EQUALITY IMPACT ASSESSMENT......................................................................5

12 HUMAN RIGHTS ....................................................................................................5

13 AUDIT AND MONITORING ....................................................................................6

APPENDIX A EQUALITY ASSESSMENT

APPENDIX B ABBREVIATIONS & DEFINITIONS

APPENDIX C PHYSICAL HEALTH FLOWCHART

APPENDIX D MONITORING PHYSICAL HEALTH NEEDS OF SMI PATIENTS IN

PRIMARY AND SECONDARY CARE

APPENDIX E LUNSERS

APPENDIX F GLASGOW ANTIPSYCHOTIC SIDE-EFFECT SCALE (GASS)

APPENDIX G CLINICAL PRACTICE GUIDANCE

EXECUTIVE SUMMARY People with mental health problems are at a significantly increased risk of a range of physical illnesses and conditions compared with the general population. Those with concurrent physical and mental health problems are also at an increased risk of these conditions negatively impacting on each other. People with serious mental illness are almost twice as likely to die from coronary heart disease as the general population and four times more likely to die from respiratory disease. There is evidence that people who use mental health services are much less likely than the general population to be offered blood pressure, cholesterol, urine or weight checks or to receive advice on smoking cessation, alcohol, exercise or diet. It is essential that there is a programme to deliver improved physical health and well being for people with SMI.

Physical Health & Examination Policy 1 V3.0

1 INTRODUCTION AND PURPOSE 1.1 People with a diagnosis of severe and enduring mental health illness, such as

schizophrenia or bipolar affective disorder are at increased risk of physical illnesses such as coronary heart disease, diabetes, respiratory disease and greater levels of obesity. In many cases weight gain is a clear side effect of medication. People with a diagnosis of schizophrenia or bipolar disorder are more than twice as likely to have diabetes than any other patients. The interaction between diabetes and schizophrenia is complex. Many people with schizophrenia have multiple risk factors for type 2 diabetes, such as family history, higher risk ethnic origin, obesity, sedentary lifestyle and smoking, and the condition itself may be a risk factor for diabetes, as well as antipsychotic medication.

1.2 There is evidence that people with mental health illnesses are likely to have their

physical health needs poorly managed and are less likely than the general population to have their blood pressure, cholesterol, urine or weight checked, or to receive advice on smoking cessation, alcohol consumption, exercise or diet.

2 OBJECTIVE 2.1 This policy sets minimum standards for the assessment and management of

physical health needs in both inpatient and community settings. Medical and nursing staff who will work alongside the Healthy Choices Staff will use their clinical judgement to undertake additional examinations or assessments as required by the patient. Once identified, physical health care need must be included in the individuals’ care plan and communicated to the patient’s GP.

3 SCOPE AND RESPONSIBILITY 3.1 This document applies in both inpatient and community settings in all areas of the

Trust, and to all doctors and nurses employed by the Trust 4 DUTIES AND RESPONSIBILITIES 4.1 The Trust Chief Executive, through the Medical Director as Lead Director, has

overall responsibility to have processes in place to ensure that staff are aware of this policy and adhere to its requirements.

4.2 Service Directors are responsible for ensuring that all operational managers in

their own areas are aware of this policy, understand its requirements and support its implementation with relevant staff.

4.3 Consultant psychiatrists are responsible for ensuring procedures are understood

and carried out by medical staff involved in the implementation of the policy. 4.4 Clinical Team Managers (Ward Managers, Community Team Managers) are

responsible for implementing the policy with their immediate staff and ensuring that staff undertake their duties described in the policy.

4.5 Members of Clinical Teams have responsibility to comply with the requirements of

this policy.


4.6 Well being support nurse must provide a have a physical health check to all new

SMI patients within 4 weeks. This must be done in liaison with Primary Care, and any investigations and results communicated to the patients GP.

4.7 All care co-ordinators must ensure that:

4.7.1 Every patient has a GP

4.7.2 Every patient has a regular physical health check (Appendix D)

4.7.3 Side effects of medication are reviewed regularly using a validated rating scale (Appendices E and F).

5 REQUIREMENTS FOR PHYSICAL ASSESSMENT OF INPATIENT SERVICE

USERS

5.1 Joint responsibility of ward / junior doctor and admitting nurse. All patients have a comprehensive physical examination within 24 hours of admission.

5.1 Medical staff are responsible for;

5.1.1 Conducting a full physical and neurological examination of all newly admitted patients.

5.1.2 For patients on anti-psychotics the examination should specifically include an assessment of side effects using a validated rating scale such as the Glasgow Antipsychotic Side-effect Scale (GASS) or LUNSERS (Appendices E and F).

5.1.3 If an examination is not possible (eg. Patient refuses or is too disturbed) the reason should be clearly stated in the notes and relevant observations documented (eg. Nutritional status, gait, abnormal movements). A full physical examination must be completed within 7 days of admission (Appendix D).

5.2 Nursing staff are responsible for baseline observations which should include

temperature, pulse, blood pressure, weight, height, Body Mass Index (BMI), urinalysis (see Appendix G, Clinical Practice Guidance).

5.3 The Healthy Choices Staff should engage with the patient at the earliest

opportunity. 5.4 Health check questions to be used in the assessment are incorporated into the

algorithm at Appendix C and include:

5.4.1 Lifestyle history

5.4.2 Health promotion advice

5.4.3 Current medication history

5.4.4 Comprehensive symptoms review


5.5 Wards must have access to resuscitation equipment which is regularly maintained. It is the responsibility of the ward manager to ensure appropriate and fully functioning medical equipment is available on all wards and that the staff. That the equipment is regularly maintained and staff receive the appropriate training.

6 FOLLOW UP OF PHYSICAL SYMPTOMS 6.1 Consultant psychiatrists follow up physical outcomes of patients with their

respective Junior Doctors at the ward review and further follow up and review if agreed and documented in the patient’s notes.

6.2 The nursing staff will refer any changes in the patient’s physical health to the ward

doctors following any vital signs monitoring and records in the patient’s notes. 6.3 Where a patient’s physical health deteriorates to the extent that specialist medical

assessment and interventions are required then transfer to an acute trust with appropriate facility to treat will occur.

6.4 Symptoms, progress and treatment of long term physical conditions such as

diabetes, hypertension etc, are reviewed with the patient by the GP every 6 months or as appropriate.

7 ON-GOING PHYSICAL HEALTH CARE OF ALL PATIENTS

7.1 Health promotion for inpatients – all patients should have access to appropriate

health promotion information, including access to exercise, smoking cessation support and appropriate dietary advice.

7.2 Any physical health assessment involving a patient undressing and/or intimate

examinations should be undertaken in the presence of a chaperone. This protects both patient and staff from inappropriate actions or allegations of inappropriate behaviours or actions. This is particularly but not exclusively important in the cases of physical examinations or procedures involving opposite sexes.

7.3 Consideration must be given regarding gender, religious and cultural sensitivities

regarding physical assessments at all times. 7.4 On discharge from inpatient care, it is the responsibility of the Care Coordinator to

ensure that the patients’ GP is made aware of the physical healthcare needs that arose during the patients’ admission. It is the RC (Responsible Clinician) responsibility to ensure that the GP receives a full discharge summary that includes all physical investigations undertaken and medication prescribed. When the patient is being discharged to the CMHT a handover must take place by the respective Well Being Support Nurse.

7.5 Weight and BP should be checked and recorded at least monthly.

7.6 Physical health review, examination and investigations should be repeated at least

every 6 months.

7.6.1 Patients should have access to dental care, chiropody, sexual health counselling and care and an optician, where appropriate.



7.6.2 Any physical health problem experienced or suspected during an inpatient episode should be referred to the duty doctor immediately.

8 TRAINING AND AWARENESS

8.1 Healthy Choices Staff will be trained, and will be responsible for providing suitable

training for other nurses and professionals. 9 STAKEHOLDER INVOLVEMENT

9.1 This policy was developed by the Wellbeing Support Steering Group, with

particular help and input from the Medical Director, Head of Nursing and Lead Nurses.

10 RECORD KEEPING 10.1 A service user’s record is a basic clinical tool used to give a clear and accurate

picture of their care and treatment, and competent use is essential in ensuring that an individual’s assessed needs are met comprehensively and in good time (General Medical Council 2006, the Royal College of Psychiatrists 2009 and Nursing and Midwifery Council 2009 Standards and NHS Record Keeping - NHS Code of Practice for Record Keeping 2006).

10.2 All NHS Trusts are required to keep full, accurate and secure records (Data

Protection Act 1998) demonstrate public value for money and manage risks (NHS Litigation Authority, Information Governance Toolkit, Essential Standards). Compliance with this Policy and these legal and best practice requirements will be evidenced through information input into the electronic record, RiO.

10.3 For full details of the specific information needed to ensure compliance with this

policy see the Data Entry Guide. 11 EQUALITY IMPACT ASSESSMENT

11.1 “All public bodies have a statutory duty under the Race Relation (Amendment) Act

2000 to “set out arrangements to assess and consult on how their policies and functions impact on race equality.” In effect to undertake equality impact assessments on all policies/guidelines and practices. This obligation has been increased to include equality and human rights with regard to disability age and gender. See Equality Assessment at Appendix A.

12 HUMAN RIGHTS 12.1 The Human Rights Act 1998 sets out fundamental provisions with respect to the

protection of individual human rights. These include maintaining dignity, ensuring confidentiality and protecting individuals from abuse of various kinds. Employees and volunteers of the Trust must ensure that requirements of the Human Rights Act are properly upheld.

13 AUDIT AND MONITORING

What will be monitored

How will it be monitored

Who will monitor Frequency Evidence to demonstrate monitoring

Action to be taken in event of non

compliance Duties : Junior doctors and Well Being Nurses undertaking assessments

Consultant meetings with Junior Doctors. At ward reviews. Reports to Clinical Governance

Consultant Ward Manager

Monthly Consultant reports to Medical Director via Clinical Governance

Action plans developed. Increased performance monitoring.

Requirements for physical assessment to be undertaken on admission

Data monitoring via Well Being Group. Audit of records.

Consultant Ward Manager

Monthly Well Being data sets

Audit notes

Increased performance monitoring via Clinical Governance

Appropriate follow up and referrals are taking place

Audit of records by Modern Matron.

Consultants Ward Manager

Monthly Annual records audit

Action plans following audit results

Ongoing assessments take place

Data monitoring of Well Being work.

Consultants Ward Manager

Monthly Annual records audit

Action plans following audit results


APPENDIX A EQUALITY ASSESSMENT EIA Screening form

1 2 3 4 5 Which of the 3 parts

does it apply to (if any) 1.Eliminating discrimination? 2.Promoting equal opportunities? 3.Promoting good relations?

Is there evidence or reason to believe that some groups could be differently affected? Which groups are affected?

How much evidence do you have? 0-2 None or little 3-4 Some 5-6 Substantial

Is there a public concern that the function/policy is being carried out in a discriminatory way? 0-2 None or little 3-4 Some 5-6 Substantial

Priority (add columns 3 & 4)

Age

3 No 0 0 0

Disability

3 No 0 0 0

Gender

3 No 0 0 0

Race

3 No 0 0 0

Religion Belief

3 No 0 0 0

Sexual orientation

3 No 0 0 0

Conclusions If the policy, procedure or practice affects any group differently, can this be legally justified?

Yes/No N/A

Does the policy/ strategy include opportunities to promote equality?

Yes/No N/A

Is there a need to gather more information than is currently available to assess the impact of the policy, procedure or practice

Yes/No (If yes, state what information is needed and how this might be collected)

N/A

Is it possible to easily modify this policy, procedure or practice to address any issues highlighted above? Please give details of how and when this could implemented

Yes/No: N/A

Conclusions Based on your answers to the

questions in this screening, what is the

1 2 3 Low* Rewrite within Withdrawn and next review date re-write

Physical Health & Examination Policy V3.0

relative priority of this policy, procedure or practice for full assessment?

* Low priority policies, procedures and practices do not

have to undergo full assessment.

If you identified this policy, procedure or practice as a 2 or 3 rating, why was this?

It is a major policy, procedure or practice, in terms of its scale or significance for Trust activities. High relevance to equality, equal opportunities or good inter-group relations/likely to have a significant impact on people from diverse groups. Possible/actual negative impact identified. Insufficient information/evidence to make a Judgement. Other_____________________________________

Please indicate the date a full assessment is proposed to commence:



APPENDIX B ABBREVIATIONS & DEFINITIONS

Abbreviation Meaning SMI Serious Mental Illness GP General Practitioner RC Responsible Clinician BMI Body Mass Index BP Blood Pressure CMHT Community Mental Health Team


Lifestyle Weight Hyperglycaemia/diabetes Lipids Blood Pressure Prolactin and/or sexual dysfunction

EPSE/akathisia/TD

Ensure baseline measurements are taken where appropriate to allow comparison and track trends over time

ALL PATIENTS WITH AN SMI DIAGNOSIS

Promote healthy lifestyle

Promote mental wellbeing

Provide routine physical health checks

Advise on diet, exercise, smoking cessation, alcohol consumption, dental health and optician

Monitor for breakthrough symptoms. Encourage attendance at outpatient / CPN appointments

Physical health checks should include endocrine, cardiovascular risks, medication side effects and lifestyle factors

Smoking Status Alcohol use Dietary advice Exercise advice Dental health Eyesight Sexual health

BMI Baseline After 1 month After every 3 months Until 1 year Then Yearly thereafter

Plasma glucose (fasting or random) Baseline After every 3 months Until 1 year Then Yearly thereafter Do GTT if indicated

Plasma lipids (fasting or random) Baseline After every 3 months Until 1 year Then Yearly thereafter

Measured Baseline 6 monthly more often if clinically indicated

Plasma prolactin levels Baseline After every 6 months if appropriate Until 1 year Then yearly thereafter More frequently if patient becomes symptomatic

Consider LUNSERS Baseline After every 6 months Yearly thereafter (if patient remains stable) More frequently if changes made to medication.

NICE recommends that Primary health care professionals are best placed to manage the physical health needs of patients with Severe Mental Illness (SMI). However NICE also states that: Secondary Care should monitor the physical health needs of all of its patients Some individuals may choose not to receive any physical care from their GP; these individuals should be monitored by secondary care.

APPENDIX C PHYSICAL HEALTH FLOWCHART

APPENDIX D MONITORING PHYSICAL HEALTH NEEDS OF SMI PATIENTS IN PRIMARY AND SECONDARY CARE

Patient Name:

Date of Assessment: Person Completing:

Date of Birth:

Consultant:

Lifestyle Blood Pressure How many cigarettes a day? Baseline 6 month 12 month How many unit of alcohol /week?

Blood Pressure

Illicit drug use Waist Circumference Risk of Pregnancy Base

1month 3month 6month 9month 12month

Liver Function Base 6 month 12 month

Full Blood Count

Base 6 month 12 month

Albumin Haemoglobin ALP Mean Cell

Volume

ALT Mean Cell Haemoglobin

GGT Red Blood Cells

Electrolyte and Creatinine


White blood cells

Sodium Neutrophils Potassium Platelets GFR Folate and

Vitamin B12 Base 6 month 12 month

Magnesium Serum Vitamin B12

Calcium Serum Folate

Diabetes/glucose Base 3 month

6 month

12 month

Thyroid Function


Blood glucose (fasting or random)

TSH

HbA1c

Free T4

Lipids Base 3 month

6 month

12 month

Prolactin (if appropriate)


Cholesterol Prolactin level

HDL/LDL ratio EPSE/TD/ akathesia

Base 3 month

6 month

12 month

ECG LUNSERS



Reference Ranges

Assay Liver Function

Albumin 35 – 50 g/L

Alkaline phosphatise (ALP) 42 – 128 U/L

Alanine transaminase (ALT) Male 0 – 70 U/L Female 0 – 50 U/L

Gamma glutamyl transferase (GGT) Male 10 – 71 U/L Female 6 – 42 U/L

Electrolyte and Creatinine

Sodium 136 – 145 mmol/L

Potassium 3.5 – 5.1 mmol/L

GFR

Magnesium 0.70 – 1.05 mmol/L

Calcium 2.1 – 2.6 mmol/L

Diabetes / Glucose

Glucose 60 – 80% of plasma glucose

Glucose (fasting) 3.3 – 6.0 mmol/L

HbA1c 6.5 – 7.5%

Lipids Cholesterol (high density lipoprotein

– HDL) Male 0.9 – 1.4

mmol/L Female 1.2 – 1.7 mmol/L

Cholesterol (total) <5.0 mmol/L

HDL/LDL Ratio

Full Blood Count

Haemoglobin Male 14.0 – 17.7 g dL-1 Female 12.0 – 16.0 g dL-1

Mean corpuscular volume (MCV) 80-96fl

White cell count 4 – 11x109/litre

Platelet count 150 – 400x109/litre

Folate and Vitamin B12

Serum B12 160 – 925 ng L-1

Serum folate 4 – 18 µg L-1

Thyroid Function

Thyroid stimulating hormone (TSH) 0.40 – 5.5 mlU/L

Thyroxine (T4, free) 10 – 23 pmol/L

Other References:

Ethnicity Waist circumference Male Female

Europeans ≥ 94 cm ≥ 80cm South Asian (Chinese, Malay, Asian-Indian) ≥ 90 cm ≥ 80 cm

Japanese ≥ 85 cm ≥ 90 cm Ethnic south & central Americans As per South Asian

USA ≥ 102 cm ≥ 88 cm Sub-Saharan Africans As per Europeans

Waist Circumference

Eastern Mediterranean & Middle East (Arab) As per Europeans

BMI Description Risk or co-morbidities

15 – 20 Underweight Increased 20 – 25 Desirable weight - 25 – 30 Overweight Increased 30 – 40 Obese Moderate to severe

BMI = weight (kg) height (m) x height (m)

Weight converter – 1lb = 0.45kg

Height converter – 1 foot (12 ins) = 30.5 cm

> 40 Morbidly obese Very severe

Correct as of: September 08 Review date: March 09


APPENDIX E LUNSERS

LUNSERS

Liverpool University Neuroleptic Side Effect Rating Scale

Date Reviewed – January 2001

Patients Name

Raters Name

Assessment Number

Assessment Date

Please indicate how much you have experienced each of the following symptoms in the last month by ticking the appropriate boxes.

NOT AT

ALL VERY

LITTLE A LITTLE QUITE A LOT

VERY MUCH

1. Rash

2. Difficulty staying awake during the day

3. Runny nose

4. Increased dreaming

5. Headaches

6. Dry mouth

7. Swollen or tender chest

8. Chilblains

9. Difficulty in concentrating

10. Constipation

11. Hair loss

12. Urine darker than usual

13. Period pains


NOT AT

ALL VERY


VERY MUCH

14. Tension

15. Dizziness

16. Feeling sick

17. Increased sex drive

18. Tiredness

19. Muscle stiffness

20. Palpitations

21. Difficulty in remembering things

22. Losing weight

23. Lack of emotions

24. Difficulty in achieving climax

25. Weak fingernails

26. Depression

27. Increased sweating

28. Mouth ulcers

29. Slowing of movements

30. Greasy skin

31. Sleeping too much

32. Difficulty passing water

33. Flushing of face

34. Muscle spasms

35. Sensitivity of sun

36. Diarrhoea

37. Over-wet or drooling mouth

38. Blurred vision


NOT AT

ALL VERY


VERY MUCH

39. Putting on weight

40. Restlessness

41. Difficulty getting to sleep

42. Neck muscles aching

43. Shakiness

44. Pins and needles

45. Painful joints

46. Reduced sex drive

47. New or unusual skin marks

48.

Parts of body moving of their own accord e.g. foot moving up and down

49. Itchy skin

50. Periods less frequent

51. Passing a lot of water


LUNSERS SCORE SHEET

Patients name

Assessors name

Date of test

Total LUNSERS score

(all 51 questions)

Score 0-4

‘Not at all’

0

‘Very little’

1

‘A little’

2

‘Quite a lot’

3

‘Very much

4

"Red Herring" item score: (questions 3,8,11,12,25,28,30,33,42,45)

Score as above (>20 high)

Total minus "red herring" score:

(0-40 = low, 41-80 = medium, 81-100 = high, >101 = very high)

Neuroleptics and doses (including PRN’s) at the time of assessment:

1. 2. 3. 4. 5.

Other relevant drugs and doses (e.g. anticholinergics, antidepressants etc.):

LUNSERS is a fully validated and comprehensive self-rating scale for measuring the distress from side effects of neuroleptics at any particular time (Day et al, B J Psych 1995, 166, 650-653). The scale rates the severity of recognised neuroleptic side effects as well as some "red herring" items to distinguish where many effects are attributed inappropriately to drugs. Users of the scale should read the article above to familiarise themselves with the test.


APPENDIX F GLASGOW ANTIPSYCHOTIC SIDE-EFFECT SCALE (GASS) Name: Age: Sex: M / F Please list current medication and total daily doses below:

This questionnaire is about how you have been recently. It is being used to determine if you are suffering from excessive side effects from your antipsychotic medication. Please place a tick in the column which best indicates the degree to which you have experienced the following side effects. Also tick the end or last box if you found that the side effect was distressing for you. © Waddell &Taylor, 2007

Over the past week: Never

Once A few times

Everyday

Tick this box if distressing

1. I felt sleepy during the day

2. I felt drugged or like a zombie

3. I felt dizzy when I stood up and/or have fainted

4. I have felt my heart beating irregularly or unusually fast

5. My muscles have been tense or jerky

6. My hands or arms have been shaky

7. My legs have felt restless and/or I couldn’t sit still

8. I have been drooling

9. My movements or walking have been slower than usual

10. I have had uncontrollable movements of my face or body

11. My vision has been blurry

12. My mouth has been dry

13. I have had difficulty passing urine

14. I have felt like I am going to be sick or have vomited

15. I have wet the bed

16. I have been very thirsty and/or passing urine frequently

17. The areas around my nipples have been sore and swollen

18. I have noticed fluid coming from my nipples

19. I have had problems enjoying sex

20. Men only: I have had problems getting an erection

Tick yes or no for the last three months No Yes Tick this box

if distressing 21. Women only: I have noticed a change in my periods

22. Men and women: I have been gaining weight


Staff Information

1. Allow the patient to fill in the questionnaire themselves. All questions relate to the

previous week. 2. Scoring

For questions 1-20 award 1 point for the answer “once”, 2 points for the answer “a few times” and 3 points for the answer “everyday”. Please note zero points are awarded for an answer of “never”.

For questions 21 and 22 award 3 points for a “yes” answer and 0 points for a “no”.

Total for all questions=

3. For male and female patients a score of: 0-21 absent/mild side effects 22-42 moderate side effects 43-63 severe side effects 4. Side effects covered include: 1-2 sedation and CNS side effects

3-4 cardiovascular side effects 5-10 extra pyramidal side effects 11-13 anticholinergic side effects 14 gastro-intestinal side effects 15 genitourinary side effects 16 screening question for diabetes mellitus 17-21 prolactinaemic side effects 22 weight gain

The column relating to the distress experienced with a particular side effect is not scored, but is intended to inform the clinician of the service user’s views and condition.


APPENDIX G CLINICAL PRACTICE GUIDANCE Blood Pressure Normal range – varies according to age and general health Adult: 100 –130 systolic 60 – 85 diastolic Older adult: 140 – 160 systolic 70 – 90 diastolic Blood Glucose Normal range – between 4mmol/l and 7mmol/l. the acceptable range for each individual patient may vary, but should be identified by doctor and recorded in patients notes. Any results outside of normal range should be reported to duty doctor Body Mass Index BMI = Weight (in Kg) ------------------ Height (in m) BMI Description Risk of co-morbidities

15-20 Underweight Increased

20-25 Desirable weight

25-30 Overweight Increased

30-40 Obese Moderate to severe

>40 Morbidly obese Very severe

Physical Health & Examination Policy · This policy sets minimum standards for the assessment and...

Documents

Transcript of Physical Health & Examination Policy · This policy sets minimum standards for the assessment and...