Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-25T04:36:38.251Z Has data issue: false hasContentIssue false
  • English
  • Français

A point prevalence study of the use of psychotropic medication in an acute general hospital

Published online by Cambridge University Press:  12 January 2016

Scott Brunero ,
Anne P. F. Wand ,
Scott Lamont  and
Lisa John
Scott Brunero*
Affiliation:
Mental Health Liaison, Prince of Wales Hospital, Randwick, NSW, Australia
Anne P. F. Wand
Affiliation:
University of New South Wales, Prince of Wales Hospital, Randwick, Sydney, Australia
Scott Lamont
Affiliation:
Mental Health Liaison, Prince of Wales Hospital, Randwick, NSW, Australia
Lisa John
Affiliation:
Pharmacy Department, Prince of Wales Hospital, Randwick, NSW, Australia
*
Correspondence should be addressed to: Scott Brunero, Clinical Nurse Consultant. Mental Health Liaison, Prince of Wales Hospital, EBB, level 1 east wing, NERU, High st Randwick 2031 NSW, Australia. Phone: 61 2 9382 2797; Fax: 61 2 9382 3035. Email: [email protected].
Get access

Abstract

Background:

There are high rates of cognitive problems and organic and functional psychiatric disorders in patients admitted to general hospital wards, which may necessitate the use of psychotropic medications. There is evidence of over-prescription of medications such as antipsychotics and antidepressants in community settings such as residential care. However, the prevalence of psychotropic use in general hospitals is unknown.

Methods:

A point prevalence study of the use of psychotropic medications in an acute general hospital was conducted by auditing medication charts for type, dose, indication, and other clinical processes associated with their use.

Results:

The files of 197 patients were audited, 139 (70%) were aged 65 years and over. Eighty-nine (45%) of patients were prescribed a psychotropic, with 35 (17.7%) antidepressants; 21 (11%) antipsychotics; 19 (10%) benzodiazepines; six (3%) mood stabilizer; five (2%) cholinesterase inhibitors; one (0.5%) anti-parkinsonian medication, and one (1%) patient on zolpidem and another patient melatonin (1%). Most prescriptions (72%) were in people 65 years and over and 27 (20%) of indications were found to be off label prescribing. There were deficits in the documentation of indications for the use of psychotropic medications and follow up arrangements.

Conclusions:

Rates of benzodiazepines use were less than that reported incomparable settings. Concerns regarding off label prescribing, under-dosing, and lack of adequate documentation of indications and follow-up instructions were raised. Given the potential adverse effects of psychotropic medication, improved governance, and education regarding their use is required.

Keywords

psychotropicgeneral hospitalmedicationelderlyprescribing
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 6 , June 2016 , pp. 967 - 975
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Australian Commission on Safety and Quality in Health Care (2013). Literature Review: Medication Safety in Australia. Sydney: Australian Commission on Safety and Quality in Health Care.Google Scholar
Australian Institute of Health Welfare (2015). Rise in Hospital Admissions for Older Australians. Canberra: Australian Government.Google Scholar
Brunero, S. and Lamont, S. (2012). The process, logistics and challenges of implementing clinical supervision in a generalist tertiary referral hospital. Scandinavian Journal of Caring Sciences, 26, 186–193.CrossRefGoogle Scholar
Bryant, C., Jackson, H. and Ames, D. (2009). Depression and anxiety in medically unwell older adults: prevalence and short-term course. International Psychogeriatrics, 21, 754–763.CrossRefGoogle ScholarPubMed
Caughey, G. E., Roughead, E. E., Shakib, S., McDermott, R. A., Vitry, A. I. and Gilbert, A. L. (2010). Comorbidity of chronic disease and potential treatment conflicts in older people dispensed antidepressants. Age and Ageing, 39, 488–494.CrossRefGoogle ScholarPubMed
Davidson, J. T., Raft, D., Lewis, B. and Gebhardt, M. (1975). Psychotropic drugs on general medical and surgical wards of a teaching hospital. Archives of General Psychiatry, 32, 507–511.CrossRefGoogle ScholarPubMed
Draper, B. and Wand, A. (in press). Behavioural and psychological symptoms of dementia. Encyclopedia of Geropsychology.Google Scholar
Elliott, R. A., Woodward, M. C. and Oborne, C. A. (2001). Improving benzodiazepine prescribing for elderly hospital inpatients using audit and multidisciplinary feedback. Internal Medicine Journal, 31, 529–535.CrossRefGoogle ScholarPubMed
Finkel, S. I., Richter, E. M. and Clary, C. M. (1999). Comparative efficacy and safety of sertraline versus nortriptyline in major depression in patients 70 and older. International Psychogeriatrics, 11, 85–99.Google Scholar
Graabæk, T. and Juel Kjeldsen, L. (2013). Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes: a systematic review. Basic and Clinical Pharmacology & Toxicology, 112, 359–373.Google Scholar
Guideline Development Group (2010). Delirium: Diagnosis, Prevention, and Management. Clinical Guideline 103. London: National Clinical Guideline Centre.Google Scholar
Haggerty, J. J. Jr, Evans, D. L., McCartney, C. F. and Raft, D. (1986). Psychotropic prescribing patterns of nonpsychiatric residents in a general hospital in 1973 and 1982. Psychiatric Services, 37, 357–361.Google Scholar
Hayes, B. D., Klein-Schwartz, W. and Barrueto, F. (2007). Polypharmacy and the geriatric patient. Clinics in Geriatric Medicine, 23, 371–390.CrossRefGoogle ScholarPubMed
Helton, T. K., McGrain, A. R. and Muliira, J. K. (2005). A case study: inappropriate use of amitriptyline in the elderly. Geriatric Nursing, 26, 317–320.CrossRefGoogle ScholarPubMed
Hirota, T. and Kishi, T. (2013). Prophylactic antipsychotic use for postoperative delirium: a systematic review and meta-analysis. Journal of Clinical Psychiatry, 74, e1136–e1144.Google Scholar
Howes, J., Ryan, J., Fairbrother, G., O’Neill, K. and Howes, L. (1996). Benzodiazipines prescribing in a Sydney teaching hospital. Medical Journal Australia, 165, 305–308.CrossRefGoogle Scholar
Karow, A. and Lambert, M. (2003). Polypharmacy in treatment with psychotropic drugs: the underestimated phenomenon. Current Opinion in Psychiatry, 16, 713–718.Google Scholar
Lamont, S., Brunero, S., Barclay, C. and Wijeratne, C. (2011). Evaluation of an ECT service in a general hospital. International Journal of Mental Health Nursing, 20, 223--229.Google Scholar
Lamont, S., Brunero, S. and Sharma, S. (2015). Application and implications of mental health act 2007 (NSW) certificate use in acute generalist settings. Australian Health Review. Epublished ahead of print, doi: 10.1071/AH15045.CrossRefGoogle Scholar
Magni, G., De Leo, D., Canton, G., Palazzolo, O., Antonielli, F. and Rossaro, P. (1984). Psychotropic drug use in an Italian general hospital. Pharmacopsychiatry, 17, 116–121.CrossRefGoogle Scholar
Meagher, D. et al. (2014). Frequency of delirium and subsyndromal delirium in an adult acute hospital population. British Journal of Psychiatry, 205, 478–485.CrossRefGoogle Scholar
Mojtabai, R. and Olfson, M. (2010). National trends in psychotropic medication polypharmacy in office-based psychiatry. Archives of General Psychiatry, 67, 26–36.CrossRefGoogle ScholarPubMed
Onder, G., Lattanzio, F., Battaglia, M., Cerullo, F., Sportiello, R. and Bernabei, R. (2011). The risk of adverse drug reactions in older patients: beyond drug metabolism. Current Drug Metabolism, 12, 647–651.CrossRefGoogle ScholarPubMed
Psychotropic Expert Group (2013). Therapeutic Guidelines: Psychotropic. Version 7. Melbourne: Therapeutic Guidelines Limited.Google Scholar
Rankin, K. and Brakoulias, V. (2012). Patterns of hypnotic medication use for sleep disturbance amongst hospital inpatients. Australasian Psychiatry, 20, 301–304.CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists (2005). Who Cares Wins. Improving the Outcome for Older People Admitted to the General Hospital.Google Scholar
Salzman, C. (1981). Psychotropic drug use and polypharmacy in a general hospital. General Hospital Psychiatry, 3, 1–9.Google Scholar
Salzman, C. (2005). Clinical Geriatric Psychopharmacology. New York: Lippincott Williams & Wilkins.Google Scholar
Salzman, C. and Van der Kolk, B. (1980). Psychotropic drug prescriptions for elderly patients in a general hospital. Journal of the American Geriatrics Society, 28, 18–22.CrossRefGoogle ScholarPubMed
Swan, J. T., Wagle, K. C., Thompson-Moore, N. and Taffet, G. E. (2013). Incidence of cholinesterase inhibitor therapy initiation among hospitalized patients. Journal of Hospital Medicine, 8, 304–308.CrossRefGoogle ScholarPubMed
Wand, A., Thoo, W., Ting, V., Sciuriaga, H., Baker, J. and Hunt, G. (2014). A multifaceted educational intervention to prevent delirium in older inpatients: a before and after study. International Journal of Nursing Studies, 51, 974–982.CrossRefGoogle ScholarPubMed
Wawruch, M., Fialova, D., Zikavska, M., Wsolova, L., Jezova, D. and Kuzelova, M. (2008). Factors influencing the use of potentially inappropriate medication in older patients in Slovakia. Journal of Clinical Pharmacy and Therapeutics, 33, 381–392.CrossRefGoogle ScholarPubMed
Westbury, J., Jackson, S., Gee, P. and Peterson, G. (2010a). An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes: the RedUSe project. International Psychogeriatrics, 22, 26–36.Google Scholar
Westbury, J. L., Jackson, S. and Peterson, G. M. (2010b). Psycholeptic use in aged care homes in Tasmania, Australia. Journal of Clinical Pharmacy and Therapeutics, 35, 189–193.CrossRefGoogle ScholarPubMed