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Improving the Process of Medication Titration in Adult ADHD Pathway
DeCates, Angharad Supported by the Quality Improvement Team
DeCates, Angharad
Supported by the Quality Improvement Team
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Affiliation
Coventry and Warwickshire Partnership NHS Trust
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Publication date
2025
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Abstract
Aim: To reduce the time taken to titrate Attention Deficit Hyperactivity Disorder (ADHD) medication and handover to shared care by 50%.
NICE NG87 outlines guidance for initiating ADHD medication for adult patients with stimulant medication: NICE & BNF advise that medication should be initiated by a specialist with the starting dose being given initially, then titrated weekly according to symptoms and adverse effects. However, standard practice in the CWPT ADHD treatment clinic has been to start medication, then follow patients up every 4 to 6 weeks. In practice, due to service pressures this is currently 2-3 months. In between clinic visits, additional prescriptions are ordered via email from patients supplying recent physical observation measurements (BP, HR, weight). There is no contact with patients in between. After titration and dose stabilisation, prescribing and monitoring of ADHD medication is carried out under Shared Care Protocol arrangements with primary care. The average time taken from initial dose to transfer of shared care is 246 days. This impacts how many patients can be commenced on medication in clinic.
Tools Used:
Stakeholder Engagement - www.aqua.nhs.uk/wp-content/uploads/2023/07/qsir-stakeholder-analysis.pdf;
PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf.
Project Impact: 74% Reduction in the average time taken to complete titration on medication.
Citation
DeCates, Angharad. Improving the Process of Medication Titration in Adult ADHD Pathway. Coventry and Warwickshire Partnership NHS Trust. 2025
Type
Internal Poster