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Characterising the nature of psychotropic medication prescribed in Scottish PICUs

Published online by Cambridge University Press:  24 February 2014

Gazala Akram ,
Anton Slavin  and
Paul Davies
Gazala Akram*
Affiliation:
Lecturer, Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, Scotland Specialist Mental Health Pharmacist, NHS Greater Glasgow & Clyde, Scotland
Anton Slavin
Affiliation:
Pharmacist, Co-Op Pharmacy, Edinburgh, Scotland
Paul Davies
Affiliation:
Specialist Mental Health Pharmacist, NHS Greater Glasgow & Clyde, Scotland
*
Correspondence to: Dr G. Akram, University of Strathclyde Pharmacy, 160 Cathedral St, Glasgow G4 0RE. E-mail: [email protected]
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Abstract

To determine the nature of psychotropic medication routinely prescribed in Scottish PICUs, the medical notes and prescription charts of 75 patients from 10 out of 14 units were consulted. These included 55 males (73%), the majority of whom were detained and had a diagnosis of schizophrenia. There was good conformance with mental health legislation treatment plans (T2/T3 forms) with only five instances of non-conformance identified. Antipsychotics were prescribed to 60 patients (80%) of which olanzapine and zuclopenthixol decanaote were the most common. The average number of regular psychotropic medicines prescribed per patient was two. In total, 14 drugs, encompassing 21 formulations, were prescribed for PRN use. Lorazepam and haloperidol were the most common PRN medicines. 76 PRN prescriptions (32%) had the oral and IM doses written on the same line of the prescription chart and showed no allowance for bioavailability when detailing the maximum dose that could be administered. 16 patients (21%) were prescribed more than one antipsychotic. Seven patients were prescribed high dose therapy, but this increased to 25 when PRN antipsychotics were included. This study provides information about psychotropic medication prescribing in Scottish PICUs and highlights areas where practice is sub-optimal.

Keywords

Psychotropicas required medicationhigh dose prescribingregular medication
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 10 , Issue 2 , August 2014 , pp. 75 - 83
Copyright
Copyright © NAPICU 2014 

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References

Baker, J., Lovell, K., Harris, N. (2008) A best-evidence synthesis review of the administration of psychotropic pro re nata (PRN) medication in in-patient mental health settings. Journal of Clinical Nursing. 17(9): 1112–1131.CrossRefGoogle ScholarPubMed
Brown, S., Chhina, N., Dye, S. (2008) The psychiatric intensive care unit: a prospective survey of patient demographics and outcomes at seven English PICUs. Journal of Psychiatric Intensive Care. 4: 17–27.CrossRefGoogle Scholar
Brown, S., Chhina, N., Dye, S. (2010) Use of psychotropic medication in seven English psychiatric intensive care units. Psychiatric Bulletin. 34: 130–135.Google Scholar
Choong, S., Coupe, T., Vijayan, J.P. (2012) A simple clinical audit of antipsychotic prescribing on Hollywell Psychiatric Intensive Care Unit (PICU). Journal of Psychiatric Intensive Care. 8: 11–14.CrossRefGoogle Scholar
Correll, C., Rummel-Kluge, C., Corves, C., Kane, J., Leucht, S. (2009) Antipsychotic combinations vs monotherapy in schizophrenia: a meta-analysis of randomized controlled trials. Schizophrenia Bulletin. 35(2): 443–457.CrossRefGoogle ScholarPubMed
Leucht, S., Komossa, K., Rummel-Kluge, C., Corves, C., Hunger, H., Schmid, F., Lobos, C., Schwarz, S., Davis, J. (2009) A meta-analysis of head-to-head comparisons of second-generation antipsychotics in the treatment of schizophrenia. American Journal of Psychiatry. 166: 152–163.CrossRefGoogle ScholarPubMed
Mental Welfare Commission for Scotland (2011) Not Properly Authorised: Unannounced visits to people receiving treatment under the safeguards of part 16 of the Mental Health (Care and Treatment) (Scotland) Act 2003. http://www.mwcscot.org.uk/media/52136/Not%20Properly%20Authorised%20Part%2016%2010-11.pdf Google Scholar
National Institute for Clinical Excellence (2005) Violence: The short term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments. NICE Clinical Guideline 25. http://www.nice.org.uk/nicemedia/live/10964/29715/29715.pdf Google Scholar
NHS QIS (2010) Intensive Psychiatric Care Units: Overview report. NHS Quality Improvement Scotland, June 2010. http://www.healthcareimprovementscotland.org/our_work/mental_health/ipcu/ipcu_national_overview.aspx Google Scholar
Paton, C., Whittington, C., Barnes, T.R. (2007) Augmentation with a second antipsychotic in patients with schizophrenia who partially respond to clozapine: a meta-analysis. Journal of Clinical Psychopharmacology. 27(2): 198–204.CrossRefGoogle ScholarPubMed
Paton, C., Barnes, T., Cavanagh, M.R., Taylor, D., Lelliott, P. (2008) High dose and combination antipsychotic prescribing in acute adult wards in the UK: the challenges posed by p.r.n. prescribing. British Journal of Psychiatry. 192: 435–439.CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists (2006) Consensus Statement on High-dose Antipsychotic Medication. London: Royal College of Psychiatrists Council Report CR138. http://www.rcpsych.ac.uk/files/pdfversion/CR138.pdf Google Scholar
Scottish Executive (2006) Configuration of Forensic Mental Health Services. Edinburgh: Scottish Executive Health Department, Directorate for Service Policy and Planning. NHS HDL (2006) 48. http://www.sehd.scot.nhs.uk/mels/HDL2006_48.pdf Google Scholar
Scottish Intercollegiate Guideline Network (2013) Management of Schizophrenia. Healthcare Improvement Scotland: SIGN Guideline 131. http://www.sign.ac.uk/pdf/sign131.pdf Google Scholar
Stroup, T., Leiberman, J., McEvoy, J., Swartz, M., Davis, S., Rosenheck, R., Perkins, D., Keefe, R., Davis, C., Severe, J., Hsiao, J. (2006) Effectiveness of olanzapine, quetiapine, risperidone and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic. American Journal of Psychiatry. 163: 611–622.CrossRefGoogle ScholarPubMed
Taylor, D., Smith, L. (2009) Augmentation of clozapine with a second antipsychotic – a meta-analysis of randomized placebo-controlled studies. Acta Psychiatra Scandinavia. 119(6): 419–425.CrossRefGoogle ScholarPubMed
Taylor, D., Mir, S., Mace, S., Whiskey, E. (2002) Co-prescribing of atypical and typical antipsychotics – prescribing sequence and documented outcome. Psychiatric Bulletin. 26: 170–172.CrossRefGoogle Scholar