Can guidelines change practice? A simple audit on antipsychotic prescriptions. Jl of Psy Intensive Care, 2012,April.

31.10.2012

High dose antipsychotic use  and poly pharmacy are  common practices.Many psychiatrists consider this as a clinical necessity though evidence base to support this practice is thin.‘Taylor 2010 argued that the concept of more antipsychotic(s) must always be or might be, ‘better’ is virtually groundless. High dose/poly pharmacy practice could increase mortality among psychiatric patients. Royal college of Psychiatrists have produced consensus statements on the use of high dose antipsychotics.

A psychiatric ICU unit in UK  reports the results of their audit examining the prescription practices before and after the guideline were adopted by the unit.

The number of patients receiving a single antipsychotic (dose within BNF limits) increased from 30% in 2005 to 55% in 2006 and the number of patients prescribed a high dose (all prescription types) declined from 33% in 2005 to  8% in 2006.

There are a number of limitations to this audit. However, it shows that prescribing practice can change  if  units  adopt and follow the recommendations/ guidelines. Educating prescribers , conducting  regular audits and providing feedback are essential for such changes.

A study of polypharmacy / high dose antipsychotic use  across different countries/ health care environments is possible if readers are interested in this. Please contact me if interested.

Summary of the article:

L Steve Choong, Tim Coupe and JayaPrabha Vijayan (2012). A simple clinical audit of antipsychotic medication prescribing on Hollywell Psychiatric Intensive Care Unit (PICU).  Journal of Psychiatric Intensive Care / Volume 8 / Issue 01 / April 2012,8, pp 11­-14

The Consenus Recommendation is avaialable  here:  http://www.rcpsych.ac.uk/usefulresources/publications/collegereports/cr/cr138.aspx

3 thoughts on “Can guidelines change practice? A simple audit on antipsychotic prescriptions. Jl of Psy Intensive Care, 2012,April.

  1. DEAR DR MANOJ
    I HAVE BEEN RECEIVING REGULAR UPDATES OF YOUR JOURNAL AND I THANK YOU FOR THE SAME. PLEASE SPECIFY THAT IS YOUR JOURNAL AVAILABLE IN HARD BIND FORM ALSO. PL GIVE ME THE OFFICIAL WEBSITE OF THIS JOURNAL TOO. ALSO I WANT TO GET TWO ARTICLE OF MINE PUBLISHED IN YOUR JOURNAL THEREFORE PLEASE TELL ME AS TO HOW I CAN CONTACT THE RELEVANT AUTHORITIES OF THIS JOURNAL FOR PUBLICATION OF MY ARTILCLES.
    REGARDS
    DR EX MAJOR AJAY KUMAR
    M.D (CIP RANCHI)

    • Dear Dr Ajay Kumar,
      thanks for the mail. The blog is providing summaries of articles published elsewhere.The aim is to draw attention to recent evidence/controversies/ ideas.
      Regards
      Manoj

  2. Neuro biologically, we do not know the full extent of the drug actions ( and interactions ) at receptor level and they ( the findings ) keep evolving. And we all are aware of the long term complications of
    ( high dose ) antipsychotics and poly pharmacy. Results ( of the audit findings ) are encouraging.

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