Sedative-hypnotic treatment in an acute psychiatric setting: comparison with best practice guidance.

Objective: The aim of this study was to review treatment patterns of sedative-hypnotic agents within an acute adult inpatient psychiatric service, compare prescribing with best-practice recommendations for use and explore potential interventions.

Setting: Two urban acute inpatient psychiatric units in the Waitemata community.

Method: A retrospective review of all consecutive admissions to these two adult psychiatric units was conducted during the period 1st January to 30th June 2002. Patient demographics, diagnosis and sedative-hypnotic treatment data were extracted from clinical files. Average benzodiazepine daily dose was calculated for each admission in diazepam equivalents (Diaz(e)).

Main Outcome Measures: Sedative-hypnotic treatment administered, duration of treatment, average daily dose, and discharge treatment.

Results: Data from 257 patients and 293 admissions were analysed. Almost all admissions (86.7%) involved treatment with a sedative-hypnotic. A benzodiazepine was prescribed for 82.6% of admissions, of which 64.9% was administered on an "as-needed (prn)" basis. Zopiclone was used in 56.7% of admissions, of which 83.7% was "as-needed (prn)" treatment. Most benzodiazepine treatment was with a single agent (61.6%) and lorazepam was the most frequently prescribed (54.8%). Over two-thirds of admissions used benzodiazepine treatment for 50% or less of the admission duration. The duration of treatment was shortest in those with a diagnosis of schizophrenia/schizoaffective disorder. Almost two-thirds of admissions were discharged without any prescription for sedative-hypnotic treatment.

Conclusion: The use of sedative-hypnotic treatment in the acute adult inpatient psychiatric environment compared favourably with best practice recommendations regarding dose, duration of treatment and discharge treatment. The study identified key areas for intervention by clinical pharmacists to ensure appropriate use of sedative-hypnotics including in-service education, regular review of all sedative-hypnotic treatment and discharge medication planning.