Sir: Harrington et al (Reference Harrington, Lelliott and Paton2002), in their description of a one-day national survey of prescribing, speculate that poor documentation of the decision to prescribe high-dose antipsychotic regimes may be due to sub-optimal record keeping, lack of awareness that the regime was high-dose or both. We have recently completed an audit cycle, which sheds light on this issue in our unit.
We audited antipsychotic prescribing in Fromeside Regional Secure Clinic for the whole of 2000 and again in the latter 6 months of 2001 (43 patients), against standards based on the Royal College Consensus statement (Royal College of Psychiatrists, 1993). The patients were male forensic detainees, all factors associated with the prescription of high dose regimes (Reference Lelliott, Paton and HarringtonLelliott et al, 2002).
Our audit showed rates of high-dose prescribing of 19% and of polypharmacy of 35% in the first period, and 31% and 46% respectively in the second period. In the first period, a clear statement of indication and decision to prescribe a highdose regime was included in only 25%, and an ECG had been performed in 0%. In the second, these standards were met in 0% and 25% of cases. Results of our first survey were presented to the teams involved and the standards circulated. It is therefore our suspicion that these poor results were due to a lack of routine prescription monitoring. We are incorporating monitoring procedures into prescription charts and case conference paperwork. Prescribing is a core medical responsibility; our patients deserve careful attention to detail.
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