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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)
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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 A greater number of individuals were in the process of being withdrawn from regular benzodiazepine or z-hypnotic prescriptions in the re-audit.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 

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