scholarly journals Neuroleptic prescribing in an adolescent psychiatric in-patient unit

1996 ◽  
Vol 20 (9) ◽  
pp. 538-540 ◽  
Author(s):  
K. Lowe ◽  
H. Smith ◽  
A. Clark
Keyword(s):  
Clinical Practice ◽  
Children And Adolescents ◽  
Antipsychotic Medication ◽  
Royal College ◽  
Psychotic Disorders ◽  
Consensus Statement ◽  
Comprehensive Evaluation ◽  
High Dose ◽  
Age Group ◽  
Antipsychotic Prescribing

The Royal College of Psychiatrists' consensus statement suggests that prescribing high dose antipsychotic medication in children and adolescents should rarely be necessary. Our objective was to study the prescribing of antipsychotic medication in a regional adolescent unit during a three-year period. We found that antipsychotic prescribing on this unit is common in psychotic disorders and often high closes are required. This is not in keeping with the recommendations of the consensus statement. Review of clinical practice on other adolescent units is needed, together with a more comprehensive evaluation of the outcome of psychotic disorders in this age group.

scholarly journals How well do psychiatric trainees interpret electrocardiographs

1996 ◽  
Vol 20 (11) ◽  
pp. 651-652 ◽  
Author(s):  
James P. Warner ◽  
Julia A. Gledhill ◽  
Frankie Connell ◽  
John G. Coghlan
Keyword(s):  
Antipsychotic Medication ◽  
Royal College ◽  
Qt Interval ◽  
Consensus Statement ◽  
High Dose ◽  
Do So

The consensus statement by the Royal College of Psychiatrists recommended that patients on high dose antipsychotic medication receive regular electro-cardiographic monitoring to identify prolongation of the QT interval. A survey of trainee psychiatrists in three hospitals investigated the accuracy with which trainees could identify this abnormality and found only 20% could do so.

scholarly journals High-dose antipsychotic treatment in clinical practice

1999 ◽  
Vol 23 (11) ◽  
pp. 661-664 ◽  
Author(s):  
Philip J. Tyson ◽  
Ann M. Mortimer ◽  
Jason A Wheeler
Keyword(s):  
Clinical Practice ◽  
Antipsychotic Medication ◽  
Royal College ◽  
Treatment Compliance ◽  
Antipsychotic Treatment ◽  
Clinical Implications ◽  
High Dose ◽  
Dose Treatment ◽  
High Dose Treatment ◽  
High Doses

Aims and methodA trust-wide audit of antipsychotic prescription was conducted in order to investigate the prevalence of high-dose treatment in a population with schizophrenia and assess compliance with Royal College of Psychiatrists' guidelines on the use of high doses. Details of antipsychotic medication were recorded and in cases of high-dose treatment compliance with the College's guidelines was assessed.ResultsSixteen out of 361 patients (4%) were receiving high-dose medication. At re-audit this figure fell to four patients (1%). High-dose treatment comprised of a combined depot and oral medication in most cases. There was poor compliance with the College's guidelines.Clinical implicationsThe study stresses the importance of monitoring patients on high-dose antipsychotics, particularly when taken in combination.

scholarly journals Antipsychotic prescribing in light of the consensus statement of the College

1997 ◽  
Vol 21 (7) ◽  
pp. 408-410 ◽  
Author(s):  
K. L. Newton ◽  
R. Murthy ◽  
J. Qureshi
Keyword(s):  
General Hospital ◽  
Royal College ◽  
Medical Staff ◽  
Consensus Statement ◽  
District General Hospital ◽  
Recommended Dose ◽  
High Dose ◽  
Prescribing Practices ◽  
Retrospective Survey ◽  
Antipsychotic Prescribing

A retrospective survey was undertaken to evaluate the prescribing practices of medical staff in a District General Hospital in light of the Consensus Statement by the Royal College of Psychiatrists on the use of high dose antipsychotics (1993). Two per cent of 247 patients were prescribed a higher than recommended dose of antipsychotic. None of these cases had been prescribed ‘supra-BNF doses of antipsychotic on a regular basis, but with the addition of ‘as required’ (PRN) medication the recommended dose was exceeded. In only one patient was the high dosage administered. A further analysis of these patients is made.

scholarly journals Use of high dose antipsychotic medication

1997 ◽  
Vol 21 (9) ◽  
pp. 566-569 ◽  
Author(s):  
Graeme Yorston ◽  
Alison Pinney
Keyword(s):  
Antipsychotic Medication ◽  
Royal College ◽  
Recommended Dose ◽  
British National Formulary ◽  
High Dose ◽  
National Formulary ◽  
Number Of Patients ◽  
Novel Method ◽  
Antipsychotic Prescribing ◽  
High Doses

An audit of antipsychotic prescribing was carried out on community and in-patient samples. A novel method of expressing total daily antipsychotic dose as a percentage of the British National Formulary maximum recommended dose was used. Of 226 patients who had been prescribed antipsychotics, 16 (7%) were found to be on high closes. Their medical notes were examined to ascertain whether the Royal College of Psychiatrists guidelines were being followed. Recommendations on ways in which practice could be improved were made and a re-audit was carried out. The number of patients receiving high doses fell to 6 (3%) out of 206.

scholarly journals High-dose antipsychotic medication

1996 ◽  
Vol 20 (11) ◽  
pp. 676-680 ◽  
Author(s):  
Peter L. Cornwall ◽  
Fuad Hassanyeh ◽  
Caprice Horn
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Practice ◽  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Maximum Dose ◽  
High Dose ◽  
National Formulary ◽  
Physical Status ◽  
High Dose Treatment

We audited the use of high-dose antipsychotic drugs in patients admitted to a special (intensive) care unit over two periods. Five out of 57 patients in the first sample and three out of 62 in the second were treated with a single antipsychotic drug above the British National Formulary maximum dose. The proportion of patients treated with antipsychotic drugs such that the total dose in chlorpromazine equivalents was greater than 1000 mg, fed. The audit showed improvements in clinical practice, particularly with respect to the onset of, indication for and outcome of high-dose treatment and in monitoring the patients' physical status.

scholarly journals [No Title]

1994 ◽  
Vol 18 (10) ◽  
pp. 647-647
Author(s):  
A. Valmana ◽  
M. Potter
Keyword(s):  
Antipsychotic Medication ◽  
Consensus Statement ◽  
High Dose

Sir: We welcome the recent Consensus Statement on the Use of High Dose Antipsychotic Medication (Thompson, 1994) but would welcome further guidance on the use of high dosages, particularly when polypharmacy is involved.

scholarly journals Monitoring patients on high-dose antipsychotics

1998 ◽  
Vol 22 (11) ◽  
pp. 671-674 ◽  
Author(s):  
Joan M. Barber ◽  
Jennifer Connaughton ◽  
Morag Wright
Keyword(s):  
Antipsychotic Medication ◽  
Consensus Statement ◽  
Journal Club ◽  
Clinical Implications ◽  
High Dose ◽  
Cardiac Events ◽  
Risk Avoidance ◽  
Similar Improvement ◽  
Prescribing Behaviour ◽  
New System

Aims and methodFollowing the publication of the 1994 Consensus Statement on the use of high-dose antipsychotic medication, we identified our high-dose patients and undertook an audit of the recommended physical investigations. The patients were identified by scrutiny of prescription records. Data were collected retrospectively at six-monthly intervals for four audit cycles. Results were fed back to clinicians at the hospital journal club.ResultsThe percentage of patients identified in the high-dose category fell from 35 to 23% over 18 months. Electrocardiograph monitoring of the group increased from 5 to 63%. Other tests showed a similar improvement. A very small number of abnormal results was shown. There were no untoward cardiac events.Clinical implicationsIntroduction of the standards of physical monitoring advised in the Consensus Statement has implications of cost to the NHS to be balanced against risk avoidance for patients. The number of abnormalities detected in our population was low. Changing prescribing behaviour in response to reported abnormal findings proved unexpectedly slow and a new system was required.

The impact of a change in prescribing policy on antipsychotic prescribing in a general adult psychiatric hospital

2014 ◽  
Vol 31 (3) ◽  
pp. 167-173 ◽  
Author(s):  
J. Kelly ◽  
F. Kelly ◽  
K. Santlal ◽  
S. O’Ceallaigh
Keyword(s):  
Mental Health ◽  
Psychiatric Hospital ◽  
Antipsychotic Medication ◽  
High Dose ◽  
Evidence Based ◽  
Second Generation Antipsychotics ◽  
Before And After ◽  
Antipsychotic Prescribing ◽  
Clinically Significant ◽  
The Impact

ObjectivesTo examine the impact of a change in local prescribing policy on the adherence to evidence-based prescribing guidelines for antipsychotic medication in a general adult psychiatric hospital.MethodsAll adult in-patients had their clinical record and medication sheet reviewed. Antipsychotic prescribed, dose prescribed and documented indications for prescribing were recorded. This was done before and after the implementation of the change in hospital antipsychotic prescribing policy.ResultsThere were no significant differences in age, sex, Mental Health Act status, psychiatric diagnosis or documented indications for prescribing multiple or high dose antipsychotics between the two groups. There was an increase in the preferential prescribing of multiple second-generation antipsychotics (p=0.01) in the context of a significant reduction in the prescribing of multiple antipsychotics overall (p=0.02). There were no significant reductions in prescribing of mixed generations of antipsychotics (p=0.12), high dose antipsychotics (p=1.00) or as required (PRN) antipsychotics (p=0.74).ConclusionsChanges in local prescribing policy can improve adherence to quality prescribing guidelines and cause clinically significant improvements in patterns of prescribing in a general adult psychiatric hospital.

scholarly journals High-dose and combination antipsychotic prescribing in acute adult wards in the UK: The challenges posed by p.r.n. prescribing

2008 ◽  
Vol 192 (6) ◽  
pp. 435-439 ◽  
Author(s):  
Carol Paton ◽  
Thomas R. E. Barnes ◽  
Mary-Rose Cavanagh ◽  
David Taylor ◽  
Paul Lelliott
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Clinical Guidelines ◽  
Standard Dose ◽  
High Dose ◽  
Quality Improvement Programme ◽  
Prescribing Practice ◽  
Improvement Programme ◽  
Antipsychotic Prescribing ◽  
The Uk

BackgroundClinical guidelines recommend the routine use of a single antipsychotic drug in a standard dose, but prescriptions for high-dose and combined antipsychotics are common in clinical practice.AimsTo evaluate the effectiveness of a quality improvement programme in reducing the prevalence of high-dose and combined antipsychotic prescribing in acute adult in-patient wards in the UK.MethodBaseline audit was followed by feedback of benchmarked data and delivery of a range of bespoke change interventions, and then by a further audit 1 year later.ResultsThirty-two services participated, submitting data for 3942 patients at baseline and 3271 patients at the 1-year audit. There was little change in the prevalence of high-dose (baseline 36%; re-audit 34%) or combined antipsychotic prescribing (baseline 43%; re-audit 39%). As required (‘p.r.n.’) prescriptions were the principal cause of both high-dose and combined antipsychotic prescribing on both occasions.ConclusionsThe quality improvement programme did not have a demonstrable impact on prescribing practice in the majority of services. Future efforts to align practice with clinical guidelines need to specifically target the culture and practice of p.r.n. prescribing.

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