Skip to main content Accessibility help

Analysis of prescribing practices in an acute psychiatric ward

  • John Tully (a1), Elizabeth Park (a1), Allison Dunne (a1), Ivan T Murray (a2), Colm McDonald (a3) and Brian P Hallahan (a4)...


Objectives: Prescription writing is a basic clinical skill for all doctors; however, errors in prescriptions are frequent and can result in significant harm to patients both from sub-therapeutic dosages and from over prescribing. This study examines the prescribing practices of ‘as required’ medications in an acute psychiatric inpatient unit attached to a university teaching hospital.

Method: A clinical audit was conducted to examine both prescribing practices of ‘as required’ medication and recording of ‘as required’ medication in nursing notes. A series of educational interventions were undertaken in an attempt to improve prescribing practices in relation to ‘as required’ medication and two further audits were completed to assess any change in practice and whether such changes were sustained.

Results: Psycho-education led to an improvement in a number of prescribing practices, including increased generic prescribing, improved documentation of indications for medication administration and increased writing of medication dosages in acceptable abbreviations. These benefits were maintained four months after the education interventions. Rates of documenting the frequency of medication correctly and recording the administration of medication in nursing notes remained low.

Conclusion: Our audit cycle clearly demonstrates that education can ameliorate prescribing practices and these improvements were maintained four months after education was delivered. However some aspects of prescribing practice remained deficient, and more focused educational interventions are required in these areas.


Corresponding author

*Correspondence Email:


Hide All
1.van Doormaal, JE, van den Bemt, PM, Mol, PGet al.Medication errors: the impact of prescribing and transcribing errors on preventable harm in hospitalised patients. Qual Saf Health Care 2009; 18: 22–7.
2.Cunney, A, Williams, D, Felly, J. Prescription monitoring in an Irish hospital. Ir Med J 2003; 96: 20–3.
3.Nirodi, A, Mitchell, A. The quality of psychotropic drug prescribing in patients in psychiatric units for the elderly. Aging Ment Health 2002; 6: 191–6.
4.Winslow, E, Nestor, V, Davidoff, SKet al.Legibility and completeness of physicians' handwritten medication orders. Heart Lung 1997; 26: 158–64.
5.Ved, P, Coupe, T. Improving prescription quality in an in-patient mental health unit: three cycles of clinical audit. Psychiat Bull 2002; 31: 293–4.
6.Hallahan, B, Murray, I, McDonald, C. Improving prescription quality in an in-patient mental health unit: three cycles of a clinical audit: letter. Psychiat Bull 2007; 31: 435.
7.Baker, JA, Lovell, K, Harris, N, Campbell, M. Multidisciplinary consensus of best practice for pro re nata (PRN) psychotropic medications within acute mental health settings: a Delphi study. J Psychiatr Ment Health Nurs 2007; 14: 478–84.
8.Geffen, J, Sorenson, L, Stokes, Jet al.Pro re nata medication for psychoses: an audit of practice in two metropolitan hospitals. Aust NZJ Psychiatry 2002; 36: 649656.
9.McGettigan, P, McManus, J, O'Shea, Bet al.Low rate of generic prescribing in the Republic of Ireland compared to England and Northern Ireland: prescribes' concerns. Ir Med J 1997; 90: 146–7.
10.Himmel, W, Simmenroth-Nayda, A, Niebling, Wet al.What do primary care patient think about generic drugs? Int J Clin Pharmacol Ther 2005; 43: 472–9.
11.Jobst, BC, Holmes, GL. Prescribing antiepileptic drugs: should patients be switched on the basis of cost? CNS Drugs 2004; 18:617–28.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed