Audit on Prescribing Practice of Depot Antipsychotic Injections in the Adult Community Mental Health Service

IntroductionThere are a number of good standard practices available for prescribing long acting antipsychotics. Adherence to these guidelines will minimise any harm to the service users.AimsTo compare depot antipsychotic prescribing practice with good standard practice guidelines of BNF, Trust and Maudsley guidelines.ObjectivesTo compare practice with standards in the areas of:– licensed indication;– dose/frequency range;– avoiding poly-pharmacy;– regular review of clinical and side effects.MethodsCase notes of a randomly selected sample of 30 patients from the depot clinic at the City East Adult Community Mental Health Team Leicester, UK were retrospectively investigated. The data collected was analysed and the results were produced. Compliance with the best practice guidelines was calculated and recommendations made based on the findings.ResultsOne hundred percent compliance was noticed in licensed indications and dose/frequency within BNF range. However, 14% patients received poly-pharmacotherapy, 86% had regular outpatient review, but only 46% had review of side effects.ConclusionsBetter quality of documentations by the clinicians, improvised technology to elicit automatic review reminders, introduction of checklist for clinics to include review of all clinically important information, wider dissemination of the findings of this investigation, and re-auditing practice to explore impact of this investigation was recommended.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Survey of Depot Antipsychotic Prescribing in Southern Adelaide

Australasian Psychiatry ◽

10.1080/j.1440-1665.2005.02196.x ◽

2005 ◽

Vol 13 (3) ◽

pp. 253-257 ◽

Cited By ~ 3

Author(s):

Peter Herriot ◽

Kamran Kheirani

Keyword(s):

Mental Health ◽

Blood Glucose ◽

Community Mental Health ◽

Dose Reduction ◽

Involuntary Movement ◽

Dose Interval ◽

Community Mental Health Service ◽

The Past ◽

Administration Interval ◽

Depot Antipsychotic

Objective: Depot antipsychotic medication (DAP) is widely used in the treatment of schizophrenia and related disorders. The objectives of this study were to (i) determine whether DAP was being prescribed in accordance with established guidelines in terms of dose, interval of administration and indications; and (ii) assess the quality of the assessment and documentation of tardive dyskinesia (TD) as well as blood glucose and lipid abnormalities. Methods: The survey was carried out between April and June 2003 at all three public hospital affiliated community mental health centres located in the southern region of Adelaide. Data were extracted from three sources: depot prescription charts, community mental health service case notes and hospital case notes. Results: Two hundred and sixty-one patients were receiving DAP. The majority (89%) had a diagnosis of schizophrenia or schizoaffective disorder. The DAP prescribed most frequently was zuclopenthixol decanoate (57%) at a modal dose of 200 mg and a modal administration interval of 2weeks. Fifty-three per cent of patients had at least one dose reduction during the course of treatment. Four per cent of patients had a case note documented diagnosis of TD. Fifty-seven per cent of patients had at least one blood glucose test in the past year, with nearly half showing high results. Forty-seven per cent of patients had at least one lipid study in the past year, with more than half having high total cholesterol and 22% having high triglycerides. Conclusion: The results of this study indicate that DAP is being used mostly for the treatment of schizophrenia and related disorders, which is in agreement with established evidence-based guidelines. The finding of at least one documented attempt at DAP dose reduction or extension of interval of administration in approximately half of the patients receiving DAP is encouraging and may have an impact on reducing the likelihood of TD. A formal TD surveillance programme using a screening tool such as the Abnormal Involuntary Movement Scale is recommended. In addition, more frequent evaluation of blood glucose and lipid levels is needed.

Download Full-text

Achieving evidence-based prescribing practice in an adult community mental health service

Psychiatric Bulletin ◽

10.1192/pb.30.2.51 ◽

2006 ◽

Vol 30 (2) ◽

pp. 51-55 ◽

Cited By ~ 4

Author(s):

Maria Moran ◽

Bangaru Raju ◽

Jean Saunders ◽

David Meagher

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Community Mental Health ◽

Health Service ◽

Evidence Based ◽

Community Mental Health Service ◽

Prescribing Practice ◽

Evidence Based Guidelines ◽

The Impact

Aims and MethodPrescribing in everyday practice frequently deviates from evidence-based guidelines. Previous work compared practice in a community mental health service with evidence-based guidelines and identified factors related to suboptimal prescribing. This study reports the impact of a multifaceted intervention on prescribing practice. A Prescribing Practice Quality (PPQ) score was generated from six key aspects of prescribing at initial assessment and again 1 year later after an intervention to reduce suboptimal prescribing practices.ResultsA total of 264 patients were attending the service at both the initial and follow-up phase and were thus exposed to the prescribing intervention. In this population, PPQ scores were significantly lower at follow-up (0.96v.0.67,P<0.001). Improved prescribing practice was predicted by receipt of adjunctive supportive inputs, such as anxiety management (P=0.003).Similarly, mean PPQ scores substantially decreased when the total patient population was considered at each time point (0.75 in 2001 and 0.52 in 2002). These results suggest a reduction in both the initiation and continuation of suboptimal practices.Clinical ImplicationsPrescribing in real-world settings can be improved by interventions that target multiple aspects of service activity. The provision of supportive inputs is a key factor in improving practice.

Download Full-text