Aims and method: We audited the caseload of an Assertive Community Treatment (ACT) team against National Institute of Clinical Excellence (NICE) guidelines in the treatment of schizophrenia. Care coordinators rated the work carried out by the team on an audit tool. Results were compared to a case note audit completed 2 years earlier.
Results: 61 patients had a primary diagnosis of schizophrenia. Rates of compliance with NICE guidelines varied from 0% (provision of advance directive) to 85% (written information given, no antipsychotic polypharmacy). Compliance was greater than in the earlier audit.
Discussion: When refusal, lack of capacity or indication were taken account of, guidelines were generally adhered to. Although a useful benchmarking process and an opportunity to identify skill deficits in the team, our findings raised concerns about simplistic notions of guideline implementation, as a means to improve practice. Patient choice is an important consideration.
