An Audit on the Prescription and Administration of ECT at NIMH Sri Lanka

Abstract

Background Audits on the practice of electroconvulsive therapy (ECT) have shown deficiencies in meeting expected standards and have highlighted the auditing of ECT as being essential for quality improvement. Aims To evaluate the practice of ECT at the National Institute of Mental Health (NIMH) Colombo, against the guidelines of the Royal College of Psychiatrists, UK and the Royal Australian and New Zealand College of Psychiatrists. Methods An audit was carried out in a consecutive sample of 111 patients. Data was collected from the patients' clinical records using a specifically designed instrument, based on the guidelines. Results The mean age of the sample was 39.9 years and 44% were males. The most commonly noted diagnosis was schizophrenia (37%) and failure to respond to first line treatment (33%) was the most frequent indication (irrespective of diagnosis) for administration of ECT. There were many inadequacies in the administration of ECT, including poor documentation of indication for ECT, inadequate monitoring of motor seizures, lack of adherence to recommended guidelines regarding modifications and poor maintenance of records. Only 50% of patients had developed a motor seizure of >20 seconds, and the average energy dose increment was 5% in subsequent ECTs. Post-ECT assessment was substandard in up to 78%. Conclusion We recommend formulating institutional guidelines in Sri Lanka to improve the administration of ECT, followed by a continuation of the audit for reevaluation of the procedure of ECT.