Table 1 Compliance achieved in relation to NICE guidelines on the appropriate use of ECT
From: Electroconvulsive therapy in Oman: a national audit of demographics and standards
Criterion | Standard | Exception | Definition of terms | Compliance achieved |
|---|---|---|---|---|
1. The individual receiving ECT has one of the following: a. Severe depressive illness b. Catatonia c. A prolonged or severe manic episode | 100% of individuals receiving ECT | None | Local clinicians will have to agree on how and where the indications for ECT are documented for audit purposes | 57.4% of individuals receiving ECT |
2. ECT is used to achieve rapid and short-term improvement of severe symptoms when an adequate trial of other treatment options has proven ineffective and/or the individual has a potentially life-threatening condition | 100% of individuals receiving ECT | None | Local clinicians will have to agree on how severe symptoms and response to other treatment options and potentially life-threatening conditions are documented for audit purposes | 100% of individuals receiving ECT |
3. An assessment of the risks and potential benefits of ECT for the individual is documented | 100% of individuals receiving ECT | None | The documented assessment before treatment should note the following: risks associated with the anesthetic; current comorbidities; anticipated adverse events, including cognitive impairment; and the risks of no treatment | 100% of individuals receiving ECT |
4. The individual provides consent for each course of ECT treatment | 100% of individuals receiving ECT | A. The individual does not have the ability to grant or refuse consent, in which case advance directives are fully taken into account and the individual’s advocate and/or carer is consulted B. The individual is detained under the Mental Health Act | Local clinicians should agree on how consent to ECT is documented for audit purposes A course of ECT is usually 6 to 12 sessions, usually given at the rate of two a week. The individual who has had/is having ECT should be asked for his/her views as to whether or not this criterion is being met | 100% of individuals receiving ECT |
5. The consent process provides that the clinician(s) responsible for treatment carries out all of the following: a. Involves the individual’s advocate and/or carer where possible b. Provides full and appropriate information in a suitable format and language to enable an informed discussion c. Explains and discusses the general risks of ECT, risks specific to the individual, and enhanced risks for individuals in specific groups and potential benefits to the individual d. Does not pressure or coerce the individual into consent to the ECT treatment e. Reminds the individual that he/she has the right to withdraw consent at any point | 100% of individuals receiving ECT | A. The individual is detained under the Mental Health Act B. The individual does not have the ability to grant or refuse consent but is compliant with treatment, and 5a-e is carried out with an advocate and/or carer | Local clinicians should agree on how the format and language used to communicate the information provided and the involvement of advocates or carers prior to consent to ECT are documented for audit purposes See 3 above for a list of general risks to be discussed Groups of people for whom there may be enhanced risks to be discussed include individuals who are pregnant older or a child or young person The individual who has had/is having ECT should be asked for his/her views as to whether or not this criterion is being met | 100% of individuals receiving ECT |
6. The individual’s clinical status is assessed after each ECT session | 100% of individuals receiving ECT | None | Local clinicians should agree on what constitutes an assessment of clinical status following an ECT session | 66% of individuals receiving ECT |
7. The individual’s cognitive function is monitored as follows: a. On an ongoing basis b. At a minimum at the end of each course of treatment | 100% of individuals receiving ECT | None | Local clinicians should agree on what constitutes monitoring of cognitive function and how monitoring is documented for audit purposes The individual who has had/is having ECT should be asked for his/her views as to whether or not this criterion is being met | 7.6% of individuals receiving ECT |
8. ECT is stopped if one of the following occurs a. A response is achieved b. There is evidence of adverse effects c. The individual withdraws consent | 100% of individuals receiving ECT | None | Local clinicians will have to agree on what constitutes a desired response and evidence of adverse effects for audit purposes The individuals who has had/is having ECT should be asked for his/her views as to whether or not this criterion is being met | 100% of individuals receiving ECT |
9. A repeat course of ECT is provided only for an individual in either one of the following circumstances a. The individual meets criteria 1 and 2 above and has previously responded well to ECT b. The individual has not responded previously but is experiencing an acute episode, and all other options have been considered and following discussion with the individual and/or where appropriate the carer or advocate of the risks and benefits of such a course of action | 100% of individuals receiving a repeat course of ECT | None | Local clinicians will have to agree on what constitutes a good response to ECT for audit purposes See 4 above for definition of course of treatment See 3 and 5 above for reference to risks | 100% of individuals receiving a repeat course of ECT |
10. ECT is used as a maintenance therapy in depressive illness | 0% of individuals receiving ECT | None | Â | 1.5% of individuals receiving ECT |
11. ECT is used for the management of schizophrenia | 0% of individuals receiving ECT | None | Â | 32.5% of individuals receiving ECT |