Improving prescription quality in an in-patient mental health unit

We read with interest the evaluation of prescription quality on an in-patient mental health unit by Ved & Coupe (Psychiatric Bulletin, August 2007, 31, ). We have recently completed an audit of prescription quality of ‘as required’ medication on our acute psychiatric in-patient ward. All prescription charts (n=90) over a 1-month period were audited, incorporating 282 prescriptions. Similar results were noted to those in the first cycle of the clinical audit by Ved & Coupe (2007). However, we had lower rates of generic prescribing (43 v. 96%) and the reason for prescribing ‘ as required’ medications was stated less frequently (17 v. 52%). There is a culture of non-generic prescribing in Ireland compared with the UK, most probably fuelled by differing legislation with regard to prescribing liability and dispensing of medications (McGettigan et al, 1997). We had higher rates of cancelling medications correctly (78 v. 40%).

Unlike Ved & Coupe (2007) we assessed whether nursing staff recorded administering ‘as required’ medications to patients in the nursing notes after signing for them in the prescription chart and found that they did in 57% of cases. In 90% of these cases an explanation was documented. Nurses were far more likely to record administering psychotropic than non-psychotropic medication (70 v. 22%, P<0.0001).

Both our study and that of Ved & Coupe (2007) demonstrate that the quality of prescribing can be improved and we agree that continuous quality assurance requires ongoing data collection, review of those data and action. The greatest deficits in prescription quality in our acute in-patient unit were in prescribing medications generically and stating a reason for prescribing ‘as required’ medication.