Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-09T03:25:49.882Z Has data issue: false hasContentIssue false
  • English
  • Français

How do we compare with best practice? A completed audit of benzodiazepine and z-hypnotic prescribing

Published online by Cambridge University Press:  23 June 2016

R. Rowntree ,
J. Sweeney ,
N. Crumlish  and
G. Flynn
R. Rowntree*
Affiliation:
Daughters of Charity Disability Support Services, St Vincent’s Centre, Navan Road, Dublin 7, Ireland
J. Sweeney
Affiliation:
Linn Dara Child and Adolescent Mental Health Services, Cherry Orchard Hospital Campus, Ballyfermot, Dublin 10, Ireland
N. Crumlish
Affiliation:
Jonathan Swift Clinic, St James’s Hospital, James’s Street, Dublin 8, Ireland
G. Flynn
Affiliation:
Jonathan Swift Clinic, St James’s Hospital, James’s Street, Dublin 8, Ireland
*
*Address for correspondence: Dr R. Rowntree, Psychiatry Registrar, Daughters of Charity Disability Support Service, St Vincent’s Centre, Navan Road, Dublin 7, Ireland. (Email: robertarowntree@hotmail.com)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To compare benzodiazepine and z-hypnotic prescribing practices in an inpatient psychiatric unit to best practice standards.

Methods

Medication charts of all inpatients in the psychiatric unit, over a 1-week period, were reviewed. Details of current benzodiazepine and z-hypnotic prescriptions were collected. Information collected included the substance prescribed, duration and administration instructions. Feedback was communicated to medical practitioners through a presentation and email. A re-audit was completed 4 months later.

Results

There were increases in total benzodiazepine and z-hypnotic prescribing despite intervention. A reduction of 2 mg occurred in the mean regular dose of benzodiazepine prescribed. Lorazepam was the most prescribed benzodiazepine throughout. In both data sets, at least 50% of regular z-hypnotics and benzodiazepines were initiated before admission. There was an increase of 14% in regular benzodiazepines initiated in hospital exceeding 4 weeks in duration. In neither data collection did regular z-hypnotics initiated in hospital exceed this cut off. A greater number of individuals were in the process of being withdrawn from regular benzodiazepine or z-hypnotic prescriptions in the re-audit. There were minimal improvements in ‘as required’ prescribing as regards documentation of an indication, time limit and maximum dose.

Conclusion

The increase in overall prescribing, despite intervention, maybe because these medications continued to be indicated in the acute presentations needing inpatient treatment. The small improvements in ‘as required’ prescribing patterns suggest that the intervention was limited in effecting change in this area.

Keywords

Auditbenzodiazepinehypnotic
Type
Short Report
Information
Irish Journal of Psychological Medicine , Volume 35 , Issue 4 , December 2018 , pp. 321 - 324
Copyright
© College of Psychiatrists of Ireland 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

Ashton, H (1994). Guidelines for the rational use of benzodiazepines. When and what to use. Drugs 1, 25–40.Google Scholar
Benzodiazepine Committee (2002). Benzodiazepines: Good Practice Guidelines for Clinicians. Department of Health and Children: Dublin (http://health.gov.ie/publications-research/publications/2002/). Accessed 16 December 2015.Google Scholar
College of Psychiatry of Ireland (2012). A consensus statement on the use of Benzodiazepines in specialist mental health services. EAP position paper. Dublin (http://www.irishpsychiatry.ie/). Accessed 15 December 2015.Google Scholar
Choke, A, Perumal, M, Howlett, M (2007). Lorazepam prescription and monitoring in acute adult psychiatric wards. Psychiatric Bulletin 31, 300–303.Google Scholar
Hallahan, B, Murray, I, McDonald, C (2009). Benzodiazepines and hypnotic prescribing in an acute adult psychiatric in-patient unit. The Psychiatrist 33, 1.Google Scholar
Haw, C, Stubbs, J (2007). Benzodiazepines a necessary evil? A survey of prescribing at a specialist UK psychiatric hospital. Journal of Psychopharmacology 21, 645–649.Google Scholar
Joint Formulary Committee (2015). British National Formulary: BNF 69. BMJ/Pharmaceutical Press: London.Google Scholar
Mental Health Commission (2009). Mental Health Commission Annual Report 2008 including report of the Inspector of Mental Health Services. Ireland (http://www.mhcirl.ie/Publications/Annual_Reports/). Accessed 16 December 2015.Google Scholar
Mental Health Commission (2010). Medication Report 2010. Ireland (http://www.mhcirl.ie/Inspectorate_of_Mental_Health_Services/Themed_Reports/). Accessed 16 December 2015.Google Scholar
Taylor, D, Paton, C, Kapur, S (editors) (2012a). Depression and anxiety. In The Maudsley Prescribing Guidelines in Psychiatry, 11th ed., pp. 197–314. Wiley-Blackwell: Chichester, UK.Google Scholar
Taylor, D, Paton, C, Kapur, S (editors) (2012b). Use of psychotrophic drugs in special patient groups. In The Maudsley Prescribing Guidelines in Psychiatry, 11th ed., pp. 531–538. Wiley-Blackwell: Chichester, UK.Google Scholar
Vandel, S, Nezelof, S, Bonin, B, et al. (1992). Consumption of benzodiazepines in a university hospital centre (in French). Encephale 18, 401–405.Google Scholar
Wheeler, A, Kairuz, T, Sheridan, J, McPhee, E (2007). Sedative-hypnotic treatment in an acute psychiatric setting: comparison with best practice guidance. Pharmacy World and Science 29, 603–610.Google Scholar