High-dose and combination antipsychotic prescribing in acute adult wards in the UK: the challenges posed by p.r.n. prescribing.
BACKGROUND
Clinical guidelines recommend the routine use of a single antipsychotic drug in a standard dose, but prescriptions for high-dose and combined antipsychotics are common in clinical practice.


OBJECTIVE
To evaluate the effectiveness of a quality improvement programme in reducing the prevalence of high-dose and combined antipsychotic prescribing in acute adult in-patient wards in the UK.


METHODS
Baseline audit was followed by feedback of benchmarked data and delivery of a range of bespoke change interventions, and then by a further audit 1 year later.


RESULTS
Thirty-two services participated, submitting data for 3,942 patients at baseline and 3,271 patients at the 1-year audit. There was little change in the prevalence of high-dose (baseline 36%; re-audit 34%) or combined antipsychotic prescribing (baseline 43%; re-audit 39%). As required ('p.r.n.') prescriptions were the principal cause of both high-dose and combined antipsychotic prescribing on both occasions.


CONCLUSIONS
The quality improvement programme did not have a demonstrable impact on prescribing practice in the majority of services. Future efforts to align practice with clinical guidelines need to specifically target the culture and practice of p.r.n. prescribing.
Paton
Carol
C
Oxleas NHS Foundation Trust, Pinewood House, Pinewood Place, Dartford, Kent DA2 7WG, UK. C.Paton@imperial.ac.uk
Barnes
Thomas R E
TR
Cavanagh
Mary-Rose
MR
Taylor
David
D
Lelliott
Paul
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006778:Hospitals, Psychiatric / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D013222:State Medicine / Q000592:standards; D006113:United Kingdom
D014150:Antipsychotic Agents