Sedative-hypnotic treatment in an acute psychiatric setting: comparison with best practice guidance
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The aim of this study was to review treatment patterns of sedative-hypnotic agents within an acute adult inpatient psychiatric service, compare prescribing with best-practice recommendations for use and explore potential interventions.
Two urban acute inpatient psychiatric units in the Waitemata community.
A retrospective review of all consecutive admissions to these two adult psychiatric units was conducted during the period 1st January to 30th June 2002. Patient demographics, diagnosis and sedative-hypnotic treatment data were extracted from clinical files. Average benzodiazepine daily dose was calculated for each admission in diazepam equivalents (Diaze).
Main outcome measures
Sedative-hypnotic treatment administered, duration of treatment, average daily dose, and discharge treatment.
Data from 257 patients and 293 admissions were analysed. Almost all admissions (86.7%) involved treatment with a sedative-hypnotic. A benzodiazepine was prescribed for 82.6% of admissions, of which 64.9% was administered on an “as-needed (prn)” basis. Zopiclone was used in 56.7% of admissions, of which 83.7% was “as-needed (prn)” treatment. Most benzodiazepine treatment was with a single agent (61.6%) and lorazepam was the most frequently prescribed (54.8%). Over two-thirds of admissions used benzodiazepine treatment for 50% or less of the admission duration. The duration of treatment was shortest in those with a diagnosis of schizophrenia/schizoaffective disorder. Almost two-thirds of admissions were discharged without any prescription for sedative-hypnotic treatment.
The use of sedative-hypnotic treatment in the acute adult inpatient psychiatric environment compared favourably with best practice recommendations regarding dose, duration of treatment and discharge treatment. The study identified key areas for intervention by clinical pharmacists to ensure appropriate use of sedative-hypnotics including in-service education, regular review of all sedative-hypnotic treatment and discharge medication planning.
KeywordsBenzodiazepine Sedative Hypnotic Prescribing Psychiatry Clinical audit Evidence-based practice New Zealand
The authors would like to thank the New Zealand Pharmacy Education Research Foundation, for financial assistance, Pharmacy student Ivy Mau for collecting the data and Mental Health Services and Pharmacy Services and staff at Waitemata District Health Board for their support.
Conflict of Interest The authors are not aware of any conflicts of interest related to this paper.
- 1.The Benzodiazepine Committee. Report of the Benzodiazepine Committee. Dublin: Department of Health and Children; 2002Google Scholar
- 2.Medicines and Healthcare Products Regulatory Agency and Committee on Safety of Medicines. Benzodiazepines, dependence and withdrawal symptoms. Current problems in Pharmacovigilence 1988;21:1–2Google Scholar
- 3.Medicines and Healthcare Products Regulatory Agency and Committee on Safety of Medicines. Zopiclone (zimovane) and neuropsychiatric reactions. Current Problems in Pharmacovigilence 1990;30:2Google Scholar
- 4.American Psychiatric Association Task Force on Benzodiazepine Dependency. Benzodiazepine dependence, toxcicity and abuse. Washington DC: American Psychiatric Association; 1990Google Scholar
- 5.The Benzodiazepine Committee. Benzodiazepines: good practice guidelines for clinicians. Dublin: Department of Health and Children; 2002Google Scholar
- 6.British Medical Association & Royal Pharmaceutical Society of Great Britain. British National Formulary. 48 ed. London, United Kingdom: British Medical Association & Royal Pharmaceutical Society of Great Britain; 2004Google Scholar
- 7.Psychotropic Drugs Committee. College guidelines for use of benzodiazepines (Practice Guideline #5). In: College Statements: Practice Guidelines: Royal Australian and New Zealand College of Psychiatrists; 1999Google Scholar
- 8.National Collaborating Centre for Nursing and Supportive Care. Violence: The short-term management of disturbed/violent behaviour in psychiatric in-patient settings and emergency departments. Clinical Guideline 25. London: National Institute for Clinical Excellence; 2005Google Scholar
- 9.Broadstock M. The effectiveness and safety of drug treatment for urgent sedation in psychiatric emergencies. NZHTA Report. Christchurch: New Zealand Health Technology Assessment Clearing House 1877235156; 2001Google Scholar
- 11.Anonymous. Australian and New Zealand clinical practice guidelines for the treatment of bipolar disorder. Aust N Z J Psychiatry 2004;38(5):280–305Google Scholar
- 12.Anonymous. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Aust N Z J Psychiatry 2005;39(1–2):1–30Google Scholar
- 16.Mahomed R, Paton C, Lee E. Prescribing hypnotics in a mental health trust: what consultant psychiatrists say and what they do. Pharm J 2002;268(5):657–659Google Scholar
- 17.Walker RA 2001 Demographic profile for Waitemata District Health Board: an analysis of 2001 census. Auckland: Regional Decision Support Team, Northern DHB Support Agency (NDSA); 2002Google Scholar
- 18.Walker RA 2001 Demographic profile for Auckland District Health Board: an analysis of 2001 census. Auckland: Regional Decision Support Team, Northern DHB Support Agency (NDSA); 2002Google Scholar
- 19.Walker RA 2001 Demographic profile for Counties Manukau District Health Board: an analysis of 2001 census. Auckland: Regional Decision Support Team, Northern DHB Support Agency (NDSA); 2002Google Scholar
- 20.Ministry of Health. National Acuity Review: Final Report on New Zealand’s Mental Health Acute Inpatient Services. Wellington: Ministry of Health; 1997Google Scholar
- 22.Bazire S. Psychotropic Drug Directory: The professionals’ pocket handbook and aide memoire. Salisbury: Fivepin Limited 0–9544839-60; 2005Google Scholar
- 23.Wheeler A, Robinson E, Robinson G. Admissions to acute psychiatric inpatient services in Auckland: demographic and diagnostic review. NZ Med J 2005;118(1226):U1752Google Scholar
- 24.Summers J, Brown KW. Benzodiazepine prescribing in a psychiatric hospital. Psychiatr Bull 1998;22:480–483Google Scholar
- 30.Royal College of Psychiatrists. Benzodiazepines: risks, benefits and dependence. A re-evaluation. Council Report CR59. London: The Royal College of Psychiatrists; January 1997Google Scholar