107 Audit of the pharmacological management of depression in palliative care

Background Depression management in palliative care is challenging. The North West Palliative Care Audit Group (NWAG) coordinated a review revealing poor adherence to guidelines. Participating organisations were therefore asked to develop action plans. Aim To audit the pharmacological management of depression against evidence-based standards (references 1–5). Methods A multi-centre retrospective case note review of patients who were commenced antidepressants for depression was undertaken. 90% compliance was deemed acceptable. Four areas were audited: assessment and diagnosis, communication, follow up and information sharing. Results Seven hospices and three hospital teams returned 58 forms. Mirtazapine was used in 67%, citalopram in 19% and sertraline in 11%. Only two sub-standards out of a total of 42 achieved compliance. These were regarding concomitant use of a benzodiazepine or a review of medication where a patient becomes agitated on initiation of antidepressant and also regarding sharing the diagnosis when a patient changed healthcare setting. Particular areas requiring improvement were documentation of: the duration of episode (50%), the severity (21%), functional impact (57%), previous episodes (30%); medications used (17%); contributory causes (76%); alternative diagnoses (34%); suicidal ideation (22%) and poor communication to patients. Only 72% were documented to have an explanation of the concept of depression, 59% regarding non-pharmacological treatments, 50% regarding side effects and 29% the lag in effect. No patients were offered written information. There was poor documentation of follow up and hand over to health care professionals. Conclusion Practice was poor in all areas except two. Findings support the need for education of staff regarding diagnosis, communication, follow up and information sharing. In particular: documentation of suicidal ideation (22%); severity (21%); past history (30%) and provision of written information to patients (0%) was poor. Recommendations were made to run educational sessions and a depression prompt was devised for local adaptation. A re-audit is planned. (References: 1–5 supplied on poster).