The 16 standards agreed for this audit are based on the NICE guideline for schizophrenia (NICE CG82, 2009).
In terms of prescribing practice, the report found:
• For service users not on clozapine, the prescribing of more than one antipsychotic medication at a time, which is only appropriate in a few circumstances, remains at an average of 11%.
• The prescribing of doses of medication above those recommended in the BNF was occurring for 10% of service users overall.
• A trial of clozapine is recommended for service users who have had a poor response to trials of two other antipsychotics. However, 28% of service users whose illness was not in remission, and who were probably appropriate for a trial of clozapine, had not yet been commenced on clozapine.
• 57% of service users currently receiving clozapine had been prescribed three or more antipsychotic medications prior to commencing clozapine, which means that their progress, to a medication more likely to be effective for them, was slower than it should have been.
• 93% of service users who were on their very first antipsychotic medication, and who were not in remission, had been on this first medication for at least six months. (If a medication is not effective it is usually not continued for more than 8 weeks.)
The report notes that these are the areas where prescribing practice can be further improved and should be prioritised by psychiatrists, mental health pharmacists and their respective professional bodies.