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Audit of antipsychotic and anticholinergic prescribing: Leeds CMHT 2000-1

Leeds Community Mental Health Trust, The Andrew Sims Centre, High Royds Hospital, Bradford Road, Menston LS29 6AQ

We read with interest the paper by Harrington et al (Psychiatric Bulletin, November 2002, 26, 414-418). It mirrored the results of a recent audit we did on atypical, high dose and co-prescribing of antipsychotics, as well as concurrent anticholinergic prescribing. Drug card information on all general adult inpatients, aged 18-65, prescribed an antipsychotic on a regular basis was collected during a single visit in April 2000. Re-audit occurred in June 2001, and on this occasion adult day hospital patients were included.

Overall, 231 inpatients received a regular prescription for an antipsychotic drug in 2000 and 321 patients in 2001 (213 in-patients and 99 day hospital patients). There were high levels of atypical antipsychotic prescribing (49%, 95% confidence interval [CI] 42-55 in 2000 and 52%, 95% CI 46-57 in 2001), co-prescribing (20%, 95% CI 15-26 in 2000 and 25, 95% CI 20-30 in 2001) and above British National Formulary (2002) limits prescribing (15%, 95% CI 11-20 in 2000 and 17%, 95% CI 12-21 in 2001) when compared to total antipsychotic prescribing. Furthermore, there were high levels of anticholinergic prescribing with atypical antipsychotics alone (21, 95% CI 13-31 in 2000 and 18%, 95% CI 12-26 in 2001).

These prescribing patterns increase the risk of side-effects and negate the cost benefits of atypical antipsychotics. They also run counter to 1993 Royal College of Psychiatrists guidelines on antipsychotic prescribing and World Health Organization anticholinergic prescribing guidelines (World Health Organization, 1990; Barnes, 1990). This audit appears to indicate problems in dissemination and a lack of widespread knowledge of current guidelines.

References

BARNES, T.R. (1990) Comment on the WHO consensus statement: prophylactic use of anticholinergics in patients on long-term neuroleptic treatment. British Journal of Psychiatry, 156, 412.[Free Full Text]

BRITISH NATIONAL FORMULARY (2002) BNF 43, March. London: British Medical Association & Royal Pharmaceutical Society.

ROYAL COLLEGE OF PSYCHIATRISTS (1993) Consensus Statement on the Use of High Dose Antipsychotic Medication. Council Report CR26. London: Royal College of Psychiatrists.

WORLD HEALTH ORGANIZATION (1990) Prophylactic Use of Anticholinergics in Patients on Long-term Neuroleptic Treatment. A Consensus Statement. Geneva: World Health Organization.

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Whicher, E. Articles by Riley, J. Search for Related Content PubMed Articles by Whicher, E. Articles by Riley, J.