Book contents
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
79 - Antipsychotics: use in dementia
from VII - Treatment
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
Summary
Setting
This audit is particularly useful in old age psychiatry. Patients could be selected from in-patient and out-patient settings.
Background
Around 800 000 people in the UK have dementia, of whom 80% will be expected to have behavioural changes or psychological symptoms in the course of their illness (Overshott & Burns, 2005). The three main types of difficult-to-manage behaviours are associated with:
ᐅ agitation/aggression
ᐅ psychosis
ᐅ mood disorder.
The National Institute for Health and Clinical Excellence (NICE) (2006) and the Drug and Therapeutics Bulletin (2007) have published guidelines on the treatment of behavioural problems in patients with dementia. However, there are no medications currently licensed in the UK for these indications.
Standards
Based on the above guidance, the following standards were obtained:
ᐅ If patients are prescribed an antipsychotic medication, there should be documentation of their severe distress or of immediate risk of harm to themselves or others.
ᐅ Before a patient is started on or switched to an antipsychotic medication, there is documentation of the fact that the prescriber has considered important comorbid conditions such as cerebrovascular disease, diabetes mellitus, Parkinson's disease and hypercholesterolaemia.
ᐅ Discussion with the patient and/or carer is documented of the rationale behind starting on or switching to an antipsychotic medication, as well as discussion of its side-effects.
Method
Data collection
A list was obtained of all patients seen by older people's mental health services within the stipulated time frame for the audit. From this, those who were diagnosed with dementia were shortlisted, and those who were started on or switched to an antipsychotic medication were identified. All documentation (hand-written, computerised and printed) was examined.
Data analysis
The proportion of case notes with appropriate documentation was noted. A standard of 100% was set. A computerised database was used to tabulate and analyse the data.
Resources required
People
It is advisable to involve at least two people for the data collection, especially where there are large numbers of case notes involved.
Time
Data collection can be a time-consuming task when examining case notes.
Results
Among 307 patients screened, only eight were started on or switched to an antipsychotic medication within the audit duration of 2 months. Quetiapine was the preferred antipsychotic. Documentation was reasonably good, although 100% compliance was not achieved.
- Type
- Chapter
- Information
- 101 Recipes for Audit in Psychiatry , pp. 189 - 190Publisher: Royal College of PsychiatristsPrint publication year: 2011