Background ADHD is a complex, diverse and common neurodevelopmental disorder, associated with many comorbidities. NICE guidelines set out the monitoring requirements for children being treated for ADHD. Wigan has more than 1000 children on its database with ADHD on medication, mostly on stimulant medication. Monitoring of the effectiveness of medication and adverse effects is crucial. Adverse effects on growth, heart rate, blood pressure changes and worsening behaviour may significantly impact the child if left unmonitored.
Objectives To review children who are on ADHD medication and to ensure parameters are monitored as per the NICE & Regional GM guidelines in order to improve our patient care.
Methods 47 patients who attended clinic in November 2018 and completed a symptom rating scale at this clinic visit were reviewed. The notes for these patients were reviewed for every clinic visit for these patients in the period January 2018 – July 2019.
Results In total we reviewed 118 clinic visits in 47 patients. 28% were age under 10 and 72% over 10. Of these 30% of under 10 were seen the minimum of 3 times a year, whereas for the over tens 44% were seen the minimum of twice a year.
Core ADHD symptoms were recorded in 30%. The effectiveness of the medication was discussed in 56% and the side effects in 9%. The ongoing need for medication was only discussed once.
Height and weight were well documented in 97% of cases, yet only 11% recorded the growth centile.
21/118 (18%) clinic visits showed a loss in weight compared with previous visit, 33% of those had a plan to address the problem.
Cardiovascular side effects monitoring was poor, with heart rate measured in 65% and blood pressure in 78%. Heart rate was found to be greater than 120 in one case but no action was taken. Blood pressure was only plotted on the centile chart in 1 case.
Symptoms like tics were discussed in 7%, seizures 0% and Sleep 59%. Worsening behaviour was discussed in 70% cases.
NICE guidelines recommend that children age under 10 should be reviewed at least 3 times per year and over 10 should be seen twice a year. In our audit only 30% of under 10s were seen three times. Monitoring of patients on medication for ADHD was not good. Height and weight should be checked in all children but this is poorly plotted on the correct growth chart. Blood pressure and heart rate are not always being checked.
The audit highlighted gaps in monitoring of our ADHD patients. Following this audit, a side effect questionnaire was introduced for use at all clinic visits. Rating scale questionnaires were also introduced to assess the effectiveness of the medication. Also we appointed a clinical pharmacist, who completed his prescribing course. Our ADHD specialist nurse also completed the prescribing course to help the paediatricians review medication as per NICE recommendation.
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