Setting

This audit is relevant to both organic and functional disorders, and to acute assessment, rehabilitation and long-stay settings.

Background

Guidelines recommend the use of benzodiazepines for the short-term relief of severe anxiety or insomnia. However, clinical experience suggests that in old age psychiatry these drugs may be being prescribed for other indications.

Standards

The standards were taken from the British National Formulary, sections 4.1.1 and 4.1.2 (Joint Formulary Committee, 2009).

ᐅ Hypnotics should be for short-term use only (2–4 weeks).

ᐅ Anxiolytics should be prescribed for the relief of severe anxiety, at the lowest possible dose for the shortest possible time (2–4 weeks).

ᐅ Benzodiazepines can also be used as antimanic agents, in the initial stages of treatment, until mood stabilisers/antimanic drugs achieve their full effect.

ᐅ In panic disorders resistant to antidepressant therapy, a benzodiazepine (lorazepam or clonazepam, both of which are unlicensed) may be used. Alternatively, benzodiazepines may be used as short-term adjunctive therapy at the start of antidepressant treatment.

ᐅ Only one benzodiazepine should be used at a time.

The aim is to follow the prescribing guidelines and to have the reasons for benzodiazepine treatment documented in all instances.

Method

Data collection

A purpose-designed data-collection form was used, mainly in ‘tick list’ format, to make it easier and quicker to fill in. The following benzodiazepines were included on the data-collection form: lorazepam, oxazepam, zopiclone, alprazolam, diazepam, zaleplon, nitrazepam, chlordiazepoxide, lormetazepam, temazepam, zolpidem, flurazepam, clobazam, clorazepate and loprazolam.

Fifty randomly selected patients were included in the audit. This was done by selecting every third patient from a list of admissions to both acute and long-stay old age psychiatry wards. Information was collected jointly from the medication cards and the patients’ medical notes.

Data analysis

The following information was collected:

ᐅ the proportion of patients prescribed benzodiazepines, broken down by gender

ᐅ the duration of use (less than or more than 4 weeks) and the type of use (as required or regular)

ᐅ the number of benzodiazepines prescribed per patient

ᐅ the indications for prescribing benzodiazepines.