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Information for service users and carers, and service user
issues
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There is a relatively
wide range of medications available for the treatment of
psychiatric conditions. The relief from symptoms provided by such
medication is often gained at the cost of unpleasant, and sometimes
disabling or harmful, side effects. When trying to choose the best
medication for an individual, it can be difficult to predict the
likely benefits and risks. It is recommended that such decisions
about medication are made by the service user and clinician in
partnership, informed by national, evidence-based
standards.
What is POMH-UK?
The national Prescribing Observatory for Mental Health
(POMH-UK) was launched in 2005 and aims to help specialist
mental health Trusts/healthcare organisations improve their
prescribing practice. POMH-UK with its member organisations
identifies specific topics within mental health prescribing and
develops audit-based quality improvement programmes (QIPs).
Organisations are able to
benchmark their performance against one another and identify where
their prescribing practice meets nationally agreed standards and
where it falls short. Wide participation in audits creates a
picture of prescribing practice nationally.
POMH-UK was originally funded by a
tapering grant from an independent charity, the Health Foundation under its
‘Engaging with Quality’ initiative. The project is now funded by
subscriptions from member organisations. POMH-UK does not receive
any funding from the pharmaceutical industry.
The partner organisations
include the Royal College of
Nursing, the United Kingdom Psychiatric
Pharmacy Group, Rethink,
Mind,
the College of Mental
Health Pharmacists, the British Association for
Psychopharmacology, and mental health service
users.
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So far, more than 60
mental health Trusts and other specialist organisations have taken
part in POMH-UK quality improvement programmes. These programmes
are based on nationally recognised standards from either standards
from the Care Quality
Commission or recommendations from various
NICE guidelines. When
a topic starts, it is necessary to look at what wards or community
teams are doing in the area in question by doing a ‘baseline’ audit
(collecting data about the subject in question). This
information about the people in hospital or the community is
collected anonymously and sent to the POMH-UK team in London.
They look at all the data and produce a report, which allows Trusts
to compare their prescribing practice with other participating
Trusts. Again this is anonymous as all Trusts have a number
that only they know.
After the baseline audit,
Trusts receive interventions to help them improve practice.
These can take the form of slide sets, good practice guides,
posters, information about the evidence base, aids to practice and
information packs. POMH-UK then re-audits using the same questions
as the first audit so the Trusts can see if there has been any
improvement.
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What type of things has POMH-UK
looked at?
So far the things POMH-UK
has looked at, or is currently looking at are:
Topic 1: High dose
and combined antipsychotics in acute adult inpatient
settings
Topic 2:
Screening for metabolic side effects of antipsychotic drugs in
patients treated by assertive outreach teams
Topic 3:
Prescribing of high dose and combined antipsychotics for patients
on forensic wards
Topic 4:
Benchmarking prescribing of anti-dementia drugs
Topic 5a:
Benchmarking the prescribing of high dose and combination
antipsychotics on adult acute and PICU wards (time-series
benchmarking)
Topic 5b: Continued benchmarking as Topic 1, using
time-series charts
Topic 6:
Assessment of side effects of depot antipsychotics
Topic
7: Monitoring of patients prescribed
lithium
Topic 8:
Medicines Reconciliation
Topic 9:
Use of antipsychotic medication in people with Learning
Disabilities
Topics
10: Use of antipsychotic medication in CAMHS
Topic 11: Use of
antipsychotics in dementia.
Topic 12: Prescribing for
people with a personality disorder
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Are there mental health service
users in POMH-UK, and where are they?
POMH UK
tries to involve service users and carers at all levels of its
work. There are service users and/or carers on every single
one of POMH's advisory groups. When a new topic is decided, a
team of expert advisors, including service users (and carers where
appropriate) is recruited to advise on all aspects of the
programme, including interventions. In addition, because Mind
and Rethink are partners in the organisation, the views of other
service users and carers are also brought to the
programme.
POMH UK have
developed a number of service user and carer led interventions,
including a popular patient-held card advising and promoting annual
physical health checks. If you are a service user or carer
and would like a free copy of the patient-held physical
health card, please email us. POMH-UK
member Trusts can order these cards in bulk, email us.
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What happens at the local
level?
When a Trust joins POMH-UK they are encouraged
to set up a local group consisting of a senior pharmacist, senior
psychiatrist and a clinical audit person. It is recommended that
nurses and service users are co-opted from relevant services for
each individual Topic.
How can service users and
carers help at the local level?
Locally
users and carers may be involved in different ways from the users
on the central team. Obviously, since auditing a service
usually requires getting information from psychiatric patient notes
(which are confidential), service users cannot be involved in this
part of the programme. However once the baseline report is
received and the interventions are introduced, the local service
users on the local POMH team are an extremely important part of the
process, because they usually know what is happening within their
services and often also what the other services users and carers in
the area want and find helpful.
For example, in Topic 2 it was suggested that
service users on antipsychotics had blood tests to look at their
blood sugars and lipids. Local service users were able
to advise on how to make this convenient and accessible for the
majority, and helped enormously to promote the use of patient-held
physical health cards in their area.
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What happens if my Trust is not a
member?
POMH-UK is genuinely committed to improving
prescribing practice and would encourage service users and carers
to persuade their Trust to become a member. See a list of
member organisations here.
My Trust is a member, but what
they do is not communicated to the service users. What should
we do?
POMH-UK wholeheartedly supports the involvement of service
users both centrally and on a local level. As with other areas of
involvement this should be undertaken in partnership with service
users and service user groups, and should follow good practice.
Because all local teams
are built in a way that makes sense in their Trust, they are all
slightly different. Some may not meet physically in a room
together, but communicate by email, or have a continuing item on
the agenda at a particular meeting. This means that that the
central POMH team cannot dictate how they involve service users,
but we aim to guide and advise local teams in ways to involve
service users as a central part of the quality improvement
process. We would suggest that all local POMH teams have at
least one service user as part of the central team, and someone
from the local POMH team is invited to user group meetings to talk
about what has been done in the Trust and allow service users to
ask them how they could be involved.
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Where do the topics come
from?
The people from
all member Trusts can suggest new topics. It helps if these
suggestions are based around national standards that either
the Care Quality Commission or the National Institute of
Health and Clinical Excellence (NICE) have made, because the people
running the Trust will be focusing in this area anyway. Other
suggestions come from the central team and the steering
group. It was the service users on the steering group who
wanted to look at side effects and this gave rise to Topic 6.
Who runs POMH-UK?
The POMH-UK team:
*Please note that POMH-UK are only able to answer service user
enquiries regarding the work of POMH-UK or service user involvement
in POMH-UK work. If you have a general query regarding mental
health care or medication, we recommend you visit one or more of
the links below, all of which have excellent information.
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Where else can I get
information about medication or being in hospital?
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The British National
Formulary:
The British National Formulary is where most
doctors get their information about medication. It lists all
drugs with the maximum dose and side-effects. It also gives
charts of medications that interact badly with each other. It
is up-dated every year.
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Choice and
Medication:
This is a site run by the UK psychiatric
pharmacy group and NIMHE (national institute for mental health in
England) about psychiatric medication.
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National Institute for Health and
Clinical Excellence (NICE):
This is the body that makes recommendations
about medication and treatment based on clinical evidence to the
NHS. NICE guidelines about mental health problems can be
found here.
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The MHRA 'Yellow Card'
scheme:
If someone has a have a side effect that has
not been listed for that medication, they can report it to the
Medicines and Healthcare products Regulatory Agency by downloading
a form from this site, filling it in and sending it back to
them.
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Mind:
A mental health charity which supports people
who have mental health problems. They provide information
leaflets on medication.
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Rethink:
A mental health charity who support people who
have mental health problems and their carers. They also work
with the Cochrane Collaboration to provide plain language summaries
about pharmacological and psychotherapeutic trials of treatments
for schizophrenia.
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National Patient Safety Agency
(NPSA):
National Patient Safety Agency is a watchdog
for the NHS. Theylead and contribute to
improved, safe patient care by
informing,
supportingand
influencingorganisations and
people working in the health sector.
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Medicines and Healthcare products
Regulatory Agency (MHRA):
The MHRA are a Government agency who license
medication and medical devises.
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The Care Quality
Commission (CQC):
If someone is in hospital under the Mental
Health Act you have certain rights. The CQC visits psychiatric
hospitals to check whether the care being given is of a good enough
quality. They are available to talk the detained patients at
that time.
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The Royal
College of Psychiatrists:
Provides information on medication and other
treatments.
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