Book contents
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
94 - Prescribing: British National Formulary limits
from VII - Treatment
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
Summary
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
▹ nitrazepam, 10 mg
▹ temazepam, 40 mg
▹ zopiclone, 7.5 mg
ᐅ Anxiolytics
▹ diazepam, 30 mg
▹ lorazepam, 4 mg
ᐅ Antipsychotics
▹ chlorpromazine, 1 g
▹ haloperidol, 30 mg
▹ amisulpride, 1.2 g
▹ aripiprazole, 30 mg
▹ clozapine, 900 mg
▹ olanzapine, 20 mg
▹ quetiapine, 750 mg
▹ risperidone, 16 mg
ᐅ Antimanics
▹ valproic acid, 2 g
▹ carbamazepine, 1.6 g
ᐅ Antidepressants
▹ venlafaxine, 375 mg
▹ citalopram, 60 mg
▹ fluoxetine, 80 mg
▹ mirtazepine, 45 mg
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.
- Type
- Chapter
- Information
- 101 Recipes for Audit in Psychiatry , pp. 219 - 220Publisher: Royal College of PsychiatristsPrint publication year: 2011