EPV276 - Adherence to STOMP principles in CAMHS learning disability services: a clinical audit of prescribing, monitoring, and multidisciplinary practice
EPV276
Adherence to STOMP principles in CAMHS learning disability services: a clinical audit of prescribing, monitoring, and multidisciplinary practice
B. T. Kece 1,*, K. Powell 1
1Psychiatry, Herefordshire and Worcestershire Health and Care NHS Trust, Hereford, United Kingdom
Introduction: Psychotropic over-prescription in people with learning disability remains a global concern. STOMP promotes lowest-effective-dose prescribing, psychosocial support, and regular review. We audited two CAMHS LD services (Hereford and Worcester) against STOMP standards.
Objectives: To compare: (1) documentation of indication and reduce/stop plans; (2) specialist initiation; (3) MDT involvement at initiation and review; (4) review frequency; (5) antipsychotic monitoring; (6) behavioural/psych support; and (7) capacity/best-interests documentation.
Methods: Retrospective case-note review using a standard pro-forma. Hereford: 20 young people (8-17y) and Worcester: 12 young people (8-17y) with moderate-severe LD with or without autism on psychotropics were randomly selected. Data was collected on: specialist initiation, reduce/stop plan, MDT input, review interval, behavioural plan, capacity/best-interests and rationale documentation along baseline/ongoing monitoring.
Results: Prescribing was specialist-initiated with rationale documented in both counties (Hereford, 90%; Worcester, 100%). Reduce/stop plans were rare (Hereford, 10%; Worcester, 17%). MDT involvement at initiation was limited in Hereford (30%) but registered more in Worcester (67%). Ongoing MDT reviews were absent in both counties. Antipsychotic use was higher in Hereford (70%) than Worcester (50%). Monitoring was complete for most in Hereford (79%) and Worcester (83%). Capacity/best-interest documentation in Worcester was fully consistent (100%) but lower in Hereford (60%). Review intervals aligned with guidance.
Table 1. Comparative findings
Metric |
Hereford (N=20) |
Worcester (N=12) |
|
Rationale documented |
18/20 (90%) |
12/12 (100%) |
|
Reduce/stop plan |
2/20 (10%) |
2/12 (17%) |
|
MDT at initiation |
6/20 (30%) |
8/12 (67%) |
|
Ongoing MDT review |
0/20 (0%) |
0/12 (0%) |
|
Review <=6 months |
20/20 (100%) |
12/12 (100%) |
|
Antipsychotic use |
14/20 (70%) |
6/12 (50%) |
|
Monitoring complete |
11/14 (79%) |
5/6 (83%) |
|
Behavioural/psych plan |
6/20 (60%) |
5/12 (41%) |
|
Capacity/best-interests |
12/20 (60%) |
12/12 (100%) |
Conclusions: Implementing the same audit in two CAMHS LD services revealed shared strengths (specialist initiation, clear rationale, timely reviews) and persistent gaps (limited de-prescribing plans, variable behavioural support, incomplete monitoring/documentation for a minority). Differences likely reflect local structures: Worcester showed stronger initiation stage with MDT discussions and capacity/best-interests recording, whereas Hereford showed clearer antipsychotic monitoring completion. Quality-improvement actions include embedding a mandatory “medication review” field in MDT pro forma, scheduled MDT follow-ups, standardised monitoring systems within the Trust, and strengthening pathways to psychological and behavioural support. These recommendations align with NHS England STOMP guidance.
Disclosure of Interest: None Declared