The Use of ‘As required’ Antimuscarinic Medication for the Treatment of Antipsychotic Drug Induced Side‐effects

Prescribing errors in psychiatry

Aims and Method

The Department of Health would like to see serious prescribing errors reduced by 40% by 2005. Little is currently known about prescribing errors made by psychiatrists. The aim of this study was to describe prescribing errors within psychiatry by analysing interventions made by pharmacists. Members of the SouthEast Thames Psychiatric Pharmacists' Network were asked to record details of prescribing errors made in their trusts during the month of May 2002.

Results

Five hundred and seventy-nine errors were reported during the study period. The majority of errors were due to clerical oversights or failure to apply clinical knowledge. In 63 cases (11%), the error could have resulted in a serious outcome.

Clinical Implications

Prescribing errors are a daily occurrence in Mental HealthTrusts, and a potentially serious error is likely to occur on a weekly basis in an average trust. Steps need to be taken to minimise the chances of errors occurring.

Medication errors in psychiatry: a comprehensive review

Medication errors are among the most common medical errors and cause significant morbidity and in some cases mortality. The objective of this article is to review the literature on medication errors in psychiatry. We completed a comprehensive search of both peer- and non-peer-reviewed articles that investigated medication errors in psychiatry. Our primary focus was to examine patient-, provider- and system-related factors that contributed to medication errors. Due to differences in research design and denominators used to determine error rates, the reported prevalence rates of medication errors in psychiatry vary widely. Patient-related factors identified as contributing to medication errors included non-adherence to medication, failure of patients to inform their various care providers about the medications they are taking and symptoms of psychiatric illnesses. Provider-related factors identified as contributing to medication errors were also identified and included clinical practices associated with prescribing, transcription, dispensing, administration and monitoring. Finally, the healthcare system also has a major role to play in reducing medication errors by ensuring seamless continuity of care, mandating medication reconciliation programmes, ensuring adequate clinical pharmacy services and supporting a nonpunitive medication error reporting system. Although the literature raises awareness of these specific contributing factors, there is still a great need for more systematic evaluations of the problem including root cause analysis. Medication errors in psychiatry have been studied almost exclusively in the inpatient setting and thus little is known about the incidence and significance in outpatient and community settings.

Patterns of antipsychotic and anticholinergic prescribing for hospital inpatients

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.