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Patterns of Antipsychotic and Anticholinergic Prescribing for Hospital Inpatients

Oxleas NHS Trust, Pinewood House, Dartford, Kent, UK.

Richard Duffett

Maria Harrington

Paul Lelliott

Royal College of Psychiatrists Research Unit, London, UK.

Chike Okocha

Oxleas NHS Trust, Queen Elizabeth Hospital, Woolwich, London, UK.

Tom Sensky

Imperial College School of Medicine, West Middlesex University Hospital, Isleworth, Middlesex, UK.

The development of atypical antipsychotics has not only given the prescriber more options, but also increased the complexity of decision making. We examined current prescribing practice for antipsychotic and anticholinergic drugs, which involved a 1-day census of all antipsychotic and anticholinergic drugs prescribed for 4191 inpatients in 49 UK mental health services. Eighty-five percent of inpatients were prescribed antipsychotics, 48% of whom were prescribed more than one. Atypical antipsychotics were widely prescribed and combined with typicals in over 60% of cases. Large doses of antipsychotics were frequently prescribed `as required'. The dose administered was always much less than the dose prescribed and nothing at all was administered against 79% of prescriptions. Antipsychotic prescribing often deviates from recommended practice. Nursing staff have considerable discretion to administer large doses of antipsychotics on an `as required' basis.

Key Words: antipsychotic • census • dose • high dose • polypharmacy • prescribing practice

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