Antipsychotic prescribing in nursing homes: an audit report

In recent years there have been concerns regarding the prescribing of antipsychotic drugs to patients with dementia in nursing homes, due to adverse effects, inappropriate indications and insufficient review. Our practice decided to look at this difficult area more closely.

The aim of this audit was to assess whether our prescribing of antipsychotic drugs in nursing homes was appropriate.

Our audit criteria for appropriate prescribing were based on National Institute for Health and Clinical Excellence (NICE) recommendations: 1 there is a clear recorded indication or target symptom (standard 100%) 2 there is a documented review of the prescription in the past six months by a GP or psychiatrist (standard 100%). Patients in nursing homes receiving antipsychotic drugs were identified from electronic case notes, using a specific nursing home Read code and British National Formulary chapter.

The first data collection (July 2008) revealed we had 81 patients in nursing homes and 22 (27%) were prescribed antipsychotic drugs. There was a clear recorded indication or target symptom in only 11 patients (50%) and a documented review of the prescription in the past six months by a general practitioner (GP) or psychiatrist in only 14 patients (64%). We discussed the results with our practice team and decided to introduce a review checklist for antipsychotic prescribing in nursing homes. The second data collection (December 2008) showed that the number of patients prescribed antipsychotic drugs had fallen to 15 (19% of total 80) and both audit criteria were met in 100% of cases.

The introduction of the checklist and six-monthly review led to an improvement in the recording of a clear indication for the antipsychotic drug and of documented review. As a practice we were pleased with the modest reduction in the prescribing of antipsychotic drugs in nursing home patients. We were satisfied that the patients who remain on these drugs are being reviewed appropriately and that the benefit of prescribing outweighs the risk.