3. THE AUDIT

Pilot phase: 01/08/96 - 31/01/97 (5 months)

The pilot phase of the project involved developing the audit forms and organising a training package. Four sites were chosen to pilot the audit and data was collected for three months. Feedback from this phase provided information to improve project methodology.

First phase: 01/02/97 - 31/07/97 (6 months)

All ECT sites were included in this phase of the project. Each site was visited and assessed in respect of current guidelines on premises, equipment, treatment protocols, training and supervision. Both medical and nursing staff were informed of the audit and trained to complete audit forms and conduct the Montgomery Asberg Depression Rating Scale (MADRS) and Clinical Global Impression scales (CGI(C)). The rating forms and assessment scales are included at Annex D.

Second phase: 01/08/97 - 31/07/98 (9 months data collection, 3 months analysis)

All sites were visited again at least once and problems in data collection identified and resolved. A questionnaire was distributed to all doctors who administer ECT to determine their attitude to ECT, their experience of training and supervision and their knowledge of the audit. Over the nine month period from 1st August 1997 to 30th April 1998 data was collected on all patients receiving ECT and included demographic information (sex, age, post code, ethnic group), patient legal and consent status and diagnosis and indication for ECT. A description of the ECT given was recorded and outcome in terms of effectiveness was measured according to changes in the Montgomery Asberg Depression Rating Scale (MADRS) and Clinical Global Impression (CGI) scores. Each ECT site was visited regularly by the project worker until such time as local staff were confident with the recording procedure. Some ambiguities in the original audit forms were identified and rectified prior to commencing the third stage but data requested remained the same (see Annex D).

A standard for nursing levels at ECT was developed in collaboration with RCN and UKCC representatives and disseminated to all ECT consultants and nursing staff (see Annex E).

Third phase: 01/08/98 - 31/07/99 (9 months data collection, 3 months analysis).

This involved an unannounced visit to each ECT suite to view a treatment session, assess whether protocols in place were being followed and how staff interacted with the patients and each other. Measurement of fabric and process with respect to the Royal College Guidelines and the CRAG Good Practice Statement on ECT was carried out at each visit during which nursing levels were monitored against the pre-set standard and anaesthetists asked for their evaluation of equipment and staffing. Training in ECT and supervision were assessed from the perspective of the doctor delivering ECT. As in Phase 2 demographic and outcome data were again collected over the same nine month period to allow direct comparisons to be made.

Project extension: 01/08/99 - 31/03/00