Physical Health Monitoring of Community Patients Under the Care of Adult Eating Disorder Service at Surrey and Borders Partnership NHS Foundation Trust

Abstract

Aims

1. 1. To determine if the physical health monitoring of patients in the Eating disorder service is done in line with the recommendations of the National Institute of Clinical Excellence (NICE) guidelines and relevant MEED Guidance on Recognition and Management.

2. 2. To determine if the current local AEDS (Adult eating disorder services) guideline for physical health monitoring of Community patients, including blood tests and ECG is adequate for community patient cohort.

Methods

1. 1. For every attendance of patients to the Outpatient Physical health monitoring Clinic (PHMC), it is expected that the physical health monitoring to be offered would include:

   • • Weight

   • • Height (if first attendance)

   • • BMI

   • • HR (Pulse rate)

   • • Sitting/Standing BP and

   • • Temperature

2. 2. Relevant Blood tests and recent ECGs on a schedule based on patient's BMI or as needed based on clinical indication.

24 patients were identified from April 2021 to December 2022. 7 patients were deemed inappropriate due to scant documentation. Of the remaining 17, 9 patients were randomly selected. 9 patients’ documentation were looked at all contacts with AEDS. The monitoring was audited at 3 single point of contact over the course of their first clinic appointment after April 2021, the middle and latest/last monitoring.

Results

1. 1. At the first clinic after April 2021 the compliance was 100% for all parameters except for the monitoring of BMI and Temperature which was 88.9%.

2. 2. At the mid-point there was 100% compliance with BMI, weight, blood pressure and pulse monitoring, there was a drop in temperature monitoring to 77.8%.

3. 3. In the last clinic monitoring for pulse and temperature dropped to 88.9% and 77.8% respectively, all other parameters showed 100% compliance.

4. 4. The frequency of monitoring ECG and blood tests in the subsequent clinics gradually dropped from 100% to 66.7% and 88.9%.

Conclusion

Reasons for decreased monitoring in Bloods and ECG.

1. 1. Documentation was missing.

2. 2. Investigations were delayed from the patient's side.

3. 3. Due to COVID-19 there was difficulty accessing the primary care appointments for investigations.

4. 4. The temperature equipment was not working properly.

Recommendations

1. 1. Keeping a fixed format for documenting PHMC. New format for documentation introduced.

2. 2. Document all the parameters checked in the patients’ electronic records on the same day.

3. 3. PHMC clinical team to upskill on ECG via training.

4. 4. Introduce weekly ECG alongside phlebotomy clinics.

5. 5. SUSS test to be done for all RED (High risk) patients and should be clearly documented in the notes.