Potentially inappropriate prescriptions in patients admitted to a psychiatric hospital
Sammanfattning
Background Very little is known about the general appropriateness of prescribing for psychiatric
patients. Aims To identify prevalence and types of potentially inappropriate prescribing (PIP) of
psychotropic and somatic medications, to assess the severity of potential clinical consequences and
to identify possible predictive factors of PIP in a sample of adult psychiatric in-patients. Methods A
descriptive, cross-sectional design using medication reviews by clinical pharmacologists to identify
PIP during a 3-month period. The setting was in-patient units in a psychiatric department of a Danish
university hospital during a 3-month period (September 2013 November 2013). Patients medication
lists (n = 207) were reviewed at the time of admission and all identified PIPs were assessed for
potential consequences by clinical pharmacologists. Results There were 349 PIP identified in 1291
prescriptions. The proportion of patients found to have at least one PIP was 123/207 (59%) and the
proportions of patients with at least one PIP assessed to be potentially serious or fatal was 69/207
(33%) and 24/207 (12%), respectively. Interactions between drugs 125/207 (36%) and too high doses
of drugs 56/207 (16%) were the most frequent PIP. Predictive factors for PIP were polypharmacy (>5
prescriptions) and having one or more somatic diagnoses. Conclusion PIP is common in psychiatric
patients and potentially fatal. Particularly polypharmacy (>5 prescriptions) and concomitant somatic
illness were associated with the probability of PIP. Improving the quality of prescribing might benefit
from an interprofessional approach and thus better training of physicians and nurses is needed in
order to minimize PIP.