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Audit of a recently introduced stimulus dosing policy in an electroconvulsive therapy clinic

Shelton Hospital, Bicton Heath, SY3 8DN;

R. Ireland, Specialist Registrar

Department of Psychiatry, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds IP3 2QZ;

M. McBreen, Formerly Clinical Audit Coordinator

Mental Health Services, Fulbourn Hospital, Cambridge, CB1 5EF;

R. Ramana, Consultant Psychiatrist^*

Box 351, Fulbourn Hospital, Fulbourn, Cambridge CB1 5EE

^* Correspondence

Aims and method To audit the clinical practice of seizure threshold estimation and subsequent stimulus dose adjustment in the electroconvulsive therapy (ECT) clinic. Case notes of patients who had ECT over a six-month period were audited. Results were discussed at an audit meeting and guidelines and training modified appropriately prior to the second cycle of the audit.

Results Initial dose titration was poor in the first period, but improved in the second. The majority of patients were insufficiently stimulated after missed seizures in both periods and stimulus doses were not being reduced following prolonged seizures.

Clinical implications The audit identified the need for continuing supervision of trainees in addition to clear training and guidelines.