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Lorazepam prescription and monitoring in acute adult psychiatric wards

  • Aislinn Choke (a1), Mani V. Perumal (a2) and Mary Howlett (a3)
Abstract
Aims and Method

This study examines prescription and monitoring of lorazepam on three acute adult psychiatric wards at a university teaching hospital. Retrospective data from 102 consecutive in-patients were analysed.

Results

There were 83 patients (81.4%) who were prescribed lorazepam, however 45 of these (46%) were never administered it. Indication for lorazepam prescription was documented by the doctor in 35 patients (42.2%). Administration by nursing staff was documented in the medical notes on 86 occasions (60.0%) and on 32 of these (37.0%) the indication was unclear. On 21 occasions (14.7%) more than 2 mg was given; 13.7% of prescriptions were not reviewed and 64% of those reviewed after more than 4 weeks.

Clinical Implications

Lorazepam was overprescribed and inadequately monitored, which may increase the risk of dependence.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Lorazepam prescription and monitoring in acute adult psychiatric wards

  • Aislinn Choke (a1), Mani V. Perumal (a2) and Mary Howlett (a3)
Submit a response

eLetters

Lorazepam in Acute Psychiatry Wards

Dr. Mukesh Kripalani, Specialist Registrar
07 January 2008

We read with interest the article by Choke, Perumal and Howlett in the August 2007 edition and can only laud their effort in focussing our attention to such an important issue, especially in terms of EWTD and New Ways of Working. However, some of their conclusions have not been debated further and hence we would like to take this opportunity to discuss some parts of their conclusions.
/> They have suggested that a “possible excess and automatic” prescription of Lorazepam. However, their survey was not designed to pick this up. Moreover they mention, out of 81.6% written up, 46% patients werenever administered the drug. They quite rightly suggest there may be pressure for on-call junior doctors to prescribe Lorazepam on admission inorder to facilitate the management of patients on wards, especially out ofhours. It also tends to be difficult to obtain information about patients at this time, and this may also lead to a lower threshold for prescription, which we feel is entirely consistent and acceptable, especially in terms of EWTD (http://www.dh.gov.uk/en/Publicationsandstatistics/Pressreleases/DH_4024795)

We clearly support the need for complete documentation of its use. The fact which however should not be overlooked is the dispensing is done by senior nurses on the ward who have had enough experience to be able to dispense the medication. Hence, on those grounds and with the advent of nurse prescribers, we feel the final responsibility lies with the dispenser, in terms of PRN usage. Due to this, we would not dismiss “patient request” out of hand as in your conclusions. The dispenser, we are sure is well aware of their responsibilities and even some clinical protocols advocate “patient request” (http://www.ashfordstpeters.nhs.uk/intranet/Ashford---/Publicatio/Clinical-P/Freedom-of-Information---Proto30.doc_cvt.htm).

We are all aware of the dependence liability of benzodiazepines. However, it’s also clear that regular use is more associated with it. Thissurvey, as pointed out by the authors, should have clearly differentiated between those regularly prescribed versus those administered on prn basis to make conclusions more realistic. The medical and nursing profession seems under siege at the moment and it will be unfair to add further to the pressure without a clear delineation of best practise.

Dr. Mukesh KripalaniSpR Liaison Psychiatry

Dr. Amanda GashConsultant Liaison Psychiatrist

Dr. Prajakta PatilST2 Psychiatric Trainee ... More

Conflict of interest: None Declared

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