Irish Journal of Psychological Medicine

Original Research

The impact of a change in prescribing policy on antipsychotic prescribing in a general adult psychiatric hospital

J. Kellya1 c1*, F. Kellya2*, K. Santlala3 and S. O’Ceallaigha4

a1 Psychiatry Lecturer, Department of Psychiatry, Cork University Hospital, Dublin, Ireland

a2 Clinical Lecturer, Trinity College & Senior Registrar, Our Lady’s Hospital Navan, Dublin, Ireland

a3 Registrar, St. Patrick’s University Hospital, Dublin, Ireland

a4 Consultant Psychiatrist, St. Patrick’s University Hospital, Dublin, Ireland, Ireland


Objectives To examine the impact of a change in local prescribing policy on the adherence to evidence-based prescribing guidelines for antipsychotic medication in a general adult psychiatric hospital.

Methods All adult in-patients had their clinical record and medication sheet reviewed. Antipsychotic prescribed, dose prescribed and documented indications for prescribing were recorded. This was done before and after the implementation of the change in hospital antipsychotic prescribing policy.

Results There were no significant differences in age, sex, Mental Health Act status, psychiatric diagnosis or documented indications for prescribing multiple or high dose antipsychotics between the two groups. There was an increase in the preferential prescribing of multiple second-generation antipsychotics (p=0.01) in the context of a significant reduction in the prescribing of multiple antipsychotics overall (p=0.02). There were no significant reductions in prescribing of mixed generations of antipsychotics (p=0.12), high dose antipsychotics (p=1.00) or as required (PRN) antipsychotics (p=0.74).

Conclusions Changes in local prescribing policy can improve adherence to quality prescribing guidelines and cause clinically significant improvements in patterns of prescribing in a general adult psychiatric hospital.

(Received January 30 2014)

(Revised March 30 2014)

(Accepted April 14 2014)

(Online publication May 09 2014)

Key words

  • Antipsychotic agents;
  • clinical audit;
  • inappropriate prescribing;
  • physician prescribing patterns;
  • schizophrenia


c1 Address for correspondence: J. Kelly, Psychiatry, Cork University Hospital, Psychiatry Department, Cork University Hospital, Cork, Co. Cork, Ireland. (Email:


*  J. Kelly and F. Kelly are joint first co-authors.