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Clinical Audit of Use of Clonazepam in General Adult Psychiatry Patients

Published online by Cambridge University Press:  20 June 2025

Nizar El Ahmadie ,
Constance Sturgess  and
Jamshid Nazari
Nizar El Ahmadie
Affiliation:
South West Yorkshire NHS Foundation Trust, Wakefield, United Kingdom
Constance Sturgess
Affiliation:
South West Yorkshire NHS Foundation Trust, Wakefield, United Kingdom
Jamshid Nazari
Affiliation:
South West Yorkshire NHS Foundation Trust, Wakefield, United Kingdom
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Abstract

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Aims: To assess adherence to local prescribing guidelines for clonazepam, including indication appropriateness, consultant oversight, documentation of unlicensed medicine forms, weekly review compliance, and discontinuation planning before discharge.

Methods: A retrospective audit was conducted on the electronic records of 234 patients under the care of the Enhanced Team West (ETW) between July 2023 and August 2024. Using a keyword search for “clonazepam”, 20 patients were identified, with 16 meeting inclusion criteria. Data on demographics, indications, prescribing teams, consultant involvement, documentation of unlicensed medicine forms, review frequency, and discontinuation plans were collected and analysed.

Results: Indication compliance: 94% of prescriptions were for appropriate indications, predominantly agitation (56%) and anxiety (19%). No cases were for epilepsy.

Consultant oversight: 88% of prescriptions were initiated or approved by a consultant psychiatrist.

Unlicensed medicine form usage: Only 6% of cases had a completed unlicensed medicine form, despite trust guidelines mandating its use.

Review frequency: Weekly reviews were documented in 100% of cases, primarily through multidisciplinary team (MDT) meetings.

Discontinuation planning: 47% of patients had a documented plan to taper or discontinue clonazepam before discharge. Among those continued post-discharge, 89% had documented attempts at dose reduction in the community.

Conclusion: This audit highlights high compliance with appropriate indications and consultant oversight but identifies areas for improvement in documentation of unlicensed medicine forms and structured discontinuation planning. Given the risks associated with prolonged clonazepam use, enhancing adherence to trust guidelines on discontinuation strategies is essential. Recommendations include improved training on unlicensed medicine documentation, reinforced discharge planning protocols, and regular re-audits to monitor adherence and patient outcomes.

Information

Type
Audit
Information
BJPsych Open , Volume 11 , Supplement S1: Abstracts from the RCPsych International Congress 2025, 23–26 June , June 2025 , pp. S232
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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

Footnotes

Abstracts were reviewed by the RCPsych Academic Faculty rather than by the standard BJPsych Open peer review process and should not be quoted as peer-reviewed by BJPsych Open in any subsequent publication.

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