Setting

This audit is appropriate for all psychiatric in-patient settings. It is designed to be carried out in conjunction with the Mental Capacity Act audit (audit 95, p. 221) and the audit of nursing administration of medication (audit 93, p. 217).

Background

Prescribing of medication is governed by various legislative acts and guidelines. Adherence to these is important and it may even be unlawful or unsafe if medications are prescribed outside certain parameters. This audit can be broken down into parts that are deemed relevant by a service. The audit can be done on all medication, be restricted to psychiatric medication, regular prescribing or ‘as required’ prescribing (p.r.n.). The British National Formulary (BNF) is produced twice each year and gives guidance on the licensed uses for medications and their maximum doses (Joint Formulary Committee, 2009).

Standards

The BNFlimits should be adhered to for each prescription of the medication in question. Below are sample adult BNFlimits for oral psychiatric medications (see each relevant chapter of the most recent issue of the BNFfor current dosage limits or medications not featured below):

ᐅ Hypnotics

ᐅ Anxiolytics

ᐅ Antipsychotics

ᐅ Antimanics

ᐅ Antidepressants

Method

Data collection

Data were collected retrospectively for a period of 3 months for all patients in a setting (e.g. for a particular team or ward). Data could also be collected prospectively after an intervention (e.g. a training session for relevant staff on BNFlimits and prescribing). The data collected relate to the presence or absence of documentation of adherence to the above standard (e.g. documentation in medication charts of a maximum dose). Each separate prescription should be checked for adherence to the standard for the audit. Notes should also be taken of any idiosyncratic prescribing (even if it technically complies with the standards) and of any difficulties in finding the data.