Changes in antipsychotic and benzodiazepine prescribing behaviour: results from the dementia care in hospitals program (DCHP).

Abstract

Aim: The DCHP found that cognitive impairment occurred in 38% of older patients. These patients may experience distress that when disruptive or possibly dangerous to themselves or others leads to psychotropic prescription. In a US study of 17,775 patients 54% 65 and over were prescribed antipsychotics, 70% for BPSD. This study examines the impact of the DCHP on inpatient prescribing behaviour. Methods: Methods The DCHP is an all of hospital staff program to improve the awareness of and communication with patients with cognitive impairment (CI) and their families. It requires screening of all patient 65 and over for CI and if present have an alert, the Cognitive Impairment Identifier, placed over the bedside. Four hospitals nationally participated, identifying 4,278 with CI of which 80 randomly selected medication records were reviewed. All doses of antipsychotics and benzodiazepines given were recorded and dose equivalence calculated. Change in total dose and prescribing behaviour was compared. Results: Results 35% of patients were prescribed either antipsychotics or benzodiazepines pre-intervention and 25% post intervention. The daily dose equivalent, PRN dosing and more than one of the same class dosing events declined for both medication groups post-intervention. No conclusions related to causality can be made but this result is intriguing considering the DCHP did not specifically train clinicians in appropriate psychotropic prescribing. It is possible that better identification of patients with CI and the use of an over bedside alert facilitated the application of known appropriate prescribing behaviour. Conclusion: Conclusion: This small study suggests the implementation of the DCHP was associated with positive change in antipsychotic and benzodiazepine prescribing behaviour.