Preparation

• Assemble your QI/data team: Include clinical, admin, and IT staff.
• Back up your database: Always back up before making bulk changes.
• Ensure access to CAT4 or equivalent audit tool: For reporting and cross-checks.
• Review relevant guides:
• Best Practice Knowledge Base
• Medical Director

Step-by-step guide

Step 1: Identify Patients on Mental Health Medications

Best Practice Premier

• Run a Medication Search:
• Go to Utilities > Search > Patients.
• Set criteria for medications commonly used in mental health (e.g., SSRIs, SNRIs, antipsychotics, mood stabilizers).
• Export or print the list of patients on these medications.
• Best Practice Knowledge Base
• Cross-Check for Diagnosis:
• Use the same search tool to filter for patients on these medications but without a coded mental health diagnosis.
• Use the “Not recorded” or “Missing” filter for mental health diagnoses.

Medical Director

• Run a Medication Search:
• Go to Search > Patients.
• Set criteria for medications indicated in mental health.
• Export or print the list of patients on these medications.
• Medical Director Help
• Cross-Check for Diagnosis:
• Use the search filters to identify patients on these medications but without a coded mental health diagnosis.
• Use the “Not recorded” or “Missing” filter for mental health diagnoses.

Step 2: Clinical Review and Action

• Review the list with clinicians:
• For each patient, determine if a mental health diagnosis is clinically indicated but not coded.
• Exclude patients where the medication is used for non-mental health indications (e.g., chronic pain, migraine). Review medications to ensure they are appropriate and safe. Consider referring eligible patients for a Home Medication Review.
• Update records as appropriate:
• If a mental health diagnosis is confirmed, ensure it is coded in the patient’s record (not free text).
• If no diagnosis is appropriate, document the alternative indication for the medication.

Step 3: Patient Follow-Up

• Contact patients as needed:
• If further assessment is required, invite the patient for a review appointment.
• Discuss the indication for the medication and update the clinical record accordingly.

Step 4: Documentation and Reflection

• Record outcomes in the patient record.
• Update the register to reflect new or updated diagnoses.
• Track the number of patients identified, reviewed, and updated.
• Reflect as a team: What worked? What could be improved for next cycle?

Key Tips and Resources

• Best Practice Premier:
• Best Practice Knowledge Base
• Medical Director:
• Search and Medication Reports
• POLAR
• Use POLAR reports to cross-check and validate your findings.

Summary table