Download Using audit support

Generalised anxiety disorder
and panic disorder
Information and support criteria
Audit support
Implementing NICE guidance
2011
Audit support: Generalised anxiety disorder and panic disorder (2011)
NICE clinical guideline 113
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This audit support accompanies the clinical guideline: ‘Generalised anxiety
disorder and panic disorder (with or without agoraphobia) in adults’ (available
online at www.nice.org.uk/guidance/CG113).
Issue date: 2011
This is a support tool for clinical audit based on the NICE guidance.
It is not NICE guidance.
Implementation of this guidance is the responsibility of local commissioners
and/or providers. Commissioners and providers are reminded that it is their
responsibility to implement the guidance, in their local context, in light of their
duties to avoid unlawful discrimination and to have regard to promoting
equality of opportunity. Nothing in this guidance should be interpreted in a way
which would be inconsistent with compliance with those duties.
National Institute for Health and Clinical Excellence
MidCity Place, 71 High Holborn, London WC1V 6NA; www.nice.org.uk
© National Institute for Health and Clinical Excellence, 2011. All rights reserved. This
material may be freely reproduced for educational and not-for-profit purposes. No
reproduction by or for commercial organisations, or for commercial purposes, is
allowed without the express written permission of NICE.
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Using audit support
The audit support document can be used to measure current practice in
generalised anxiety disorder and panic disorder (with or without agoraphobia)
in adults against the recommendations in the NICE guideline. Use it for a local
audit project either by using the whole tool or by amending it to suit the
project.
The sample for this audit should include adults with generalised anxiety
disorder or panic disorder (with or without agoraphobia). Select an appropriate
sample in line with your project aims or local clinical audit strategy.
This audit support is aimed at ascertaining whether the person with
generalised anxiety disorder or panic disorder received the best possible care,
had input into their treatment and received the right information at the right
time. Some of this information may not be recorded in the patient records, so
it is recommended that a different approach is taken to find the information,
such as clinicians reviewing their last ten patients or multidisciplinary teams
reviewing a small number of patients.
Links with other clinical audit priorities
The audit based on this guideline should be considered in conjunction with
other clinical audit priorities such as:

NICE Generalised Anxiety Disorder clinical criteria:
www.nice.org.uk/guidance/CG113/AuditSupport

The National Audit of Psychological Therapies:
www.rcpsych.ac.uk/quality/quality,accreditationaudit/psychologicalthera
pies.aspx
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Information and support criteria for ‘Generalised anxiety disorder and
panic disorder’
People with generalised anxiety disorder (GAD)
1
Did you offer an interpreter if the person needed one?
2
Did you offer the person with GAD information about:

local self-help organisations?

national self-help organisations?

support groups?
Yes
No
Not
applicable/
exception
Written
Verbal
None
Do you have this information as standard in your consulting area
(or elsewhere in the practice)?
3
Was the treatment offered to the person with GAD based on their
preference?
4
Before prescribing any medication did you provide written and
verbal information on:

the likely benefits of different treatments

the different propensities of each drug for:

-
side effects
-
withdrawal syndromes
-
drug interactions
the risk of activation with SSRIs and SNRIs, with
symptoms such as:
-
increased anxiety
-
agitation
-
problems sleeping

the gradual development, over 1 week or more, of the full
anxiolytic effect

the importance of:
-
taking medication as prescribed
-
the need to continue treatment after remission to
avoid relapse?
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People with panic disorder
5
Yes
No
Not
applicable/
exception
Was information provided to the person with panic disorder
about:
 the nature of panic disorder
 the course of panic disorder
 treatment of panic disorder?
Was this information also provided to families and carers if
appropriate?
6
Did you inform the person with panic disorder about self-help
groups and support groups?
Did you encourage the person to participate in such programmes
where appropriate?
7
Was any written material given in the language of the person
where appropriate?
Was an interpreter used if needed?
8
If the person was offered antidepressants, at the time that
treatment was initiated was information provided on:

potential side effects (including transient increase in
anxiety at the start of treatment)?

the risk of discontinuation/withdrawal symptoms if the
treatment is stopped abruptly or in some instances if a
dose is missed or, occasionally, on reducing the dose of
the drug?
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Further information
For further information about clinical audit refer to a local clinical audit
professional within your own organisation or the Healthcare Quality
Improvement Partnership (HQIP) website www.hqip.org.uk. HQIP was
established in April 2008 to promote quality in healthcare, and in particular to
increase the impact that clinical audit has on healthcare quality in England
and Wales.
Supporting implementation
NICE has developed tools to help organisations implement the clinical
guideline on Generalised anxiety disorder and panic disorder (listed below).
These are available on our website (www.nice.org.uk/guidance/CG113).
 Costing template and statement to estimate the national and local savings
and costs associated with implementation.
 Slides highlighting key messages for local discussion.
 Clinical case scenarios for primary care to assess and improve users’
knowledge of the guideline and its application in primary care.
 Baseline assessment tool for identifying current practice and prioritising
implementation of the guideline.
 Audit support for local clinical audit
-
Audit tool listing clinical criteria
-
Audit tool listing information and support criteria
A series of practical guides to implementation is also available on our website
(www.nice.org.uk/usingguidance/implementationtools).
The guidance
You can download the guidance documents from
www.nice.org.uk/guidance/CG113. For printed copies of the quick reference
guide or ‘Understanding NICE guidance’, phone NICE publications on 0845
003 7783 or email [email protected] and quote N2409 (quick
reference guide) and/or N2410 (‘Understanding NICE guidance’).
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