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Inpatient treatment for Anorexia Nervosa – can we learn from each other’s protocols?
- Dr. Schalk W. du Toit, Dr. Philip S. Crockett (15 July 2009)
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Dr. Schalk W. du Toit, Specialty Registrar ST5 - General Adult Psychiatry NHS Grampian, Dr. Philip S. Crockett
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s_dutoit{at}doctors.org.uk Dr. Schalk W. du Toit, et al.
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We read with interest the self-evaluation of a structured in-patient treatment programme for child and adolescent patients with anorexia nervosa in Manchester, as reported by E. Rous et al (2009). Clearly the sample size is small, and hence they could not reach statistical significant results, but the improvements demonstrated in physical monitoring and assessments are to be expected with the framework provided by the protocol, and are certainly welcome given the current emphasis on NICE guidelines (2004)(1) adherence. We would have liked more information on the protocols used in their different colour bands, e.g. the type of assessments, investigations and monitoring for each weight: height ratio group, and also whether improvements were noted in all of the colour bands. We note the absence of bone density examinations from Table 1. It would have been interesting to know if these had also increased. In our newly opened Eden Unit (In-patient Eating Disorders unit at the Royal Cornhill Hospital in Aberdeen – admitting patients over 18 years of age from regional North of Scotland), we operate a grid-like system. We differentiate between high, medium and low risk patients, and also use a colour coding system. However, this is not only determined by a patient’s weight: height ratio, but also by physical symptoms, eating disorder behaviours, blood results, and other complexities and co-morbidities. For example, certain treatment measures would be triggered by events in the high risk group, and here close liaison with an attached Gastroenterology team has proven to be invaluable. Patients have individualised care plans, which are developed by means of a biopsychosocial formulation. Our experience in the context of a new unit is that the increased structure provided by such a framework is invaluable in the unit’s development, in terms of efficiently generating good standards of treatment and care. Our clinical protocol draws information from various sources, including the NHS-QIS (Quality Improvement Scotland) – Eating Disorders in Scotland guidelines (2006)(2), and is not solely based on the NICE guidelines. The Lothian-based ANITT (Anorexia Intensive Treatment Team)(3) on-line material had been especially helpful as a source of reference, as well as guidance from the Yorkshire Centre for Eating Disorders(4). After a relatively brief period of co-ordinating treatment in an in-patient environment, we see a great value in such protocols in helping to guide staff, as well as informing and motivating patients. The recently started national process of looking at quality assurance in eating disorder treatment provision, as set in motion by the Eating Disorders Section of the Royal College of Psychiatrists (2009), should also be helpful in standardising treatments in this challenging area. Declaration of interest: None References: (1) NICE guidelines - Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders (Jan 2004) (2) NHS-QIS - Eating Disorders in Scotland Recommendations for healthcare professionals (Nov 2006) (3) http://www.anitt.org.uk/ (4) http://www.yced.nhs.uk/ |
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