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Original papers: Aislinn Choke, Mani V. Perumal, and Mary Howlett Lorazepam prescription and monitoring in acute adult psychiatric wards Psychiatr Bull 2007; 31: 300-303 [Abstract] [Full text] [PDF]

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Lorazepam in Acute Psychiatry Wards

Dr. Mukesh Kripalani, Dr. Amanda Gash, Dr. Prajakta Patil   (7 January 2008)

Lorazepam in Acute Psychiatry Wards 7 January 2008
Dr. Mukesh Kripalani, Specialist Registrar Northern Deanery, Dr. Amanda Gash, Dr. Prajakta Patil Send letter to journal: Re: Lorazepam in Acute Psychiatry Wards drmukesh{at}doctors.org.uk Dr. Mukesh Kripalani, et al.	We read with interest the article by Choke, Perumal and Howlett in the August 2007 edition and can only laud their effort in focussing our attention to such an important issue, especially in terms of EWTD and New Ways of Working. However, some of their conclusions have not been debated further and hence we would like to take this opportunity to discuss some parts of their conclusions. They have suggested that a “possible excess and automatic” prescription of Lorazepam. However, their survey was not designed to pick this up. Moreover they mention, out of 81.6% written up, 46% patients were never administered the drug. They quite rightly suggest there may be pressure for on-call junior doctors to prescribe Lorazepam on admission in order to facilitate the management of patients on wards, especially out of hours. It also tends to be difficult to obtain information about patients at this time, and this may also lead to a lower threshold for prescription, which we feel is entirely consistent and acceptable, especially in terms of EWTD (http://www.dh.gov.uk/en/Publicationsandstatistics/Pressreleases/DH_4024795) We clearly support the need for complete documentation of its use. The fact which however should not be overlooked is the dispensing is done by senior nurses on the ward who have had enough experience to be able to dispense the medication. Hence, on those grounds and with the advent of nurse prescribers, we feel the final responsibility lies with the dispenser, in terms of PRN usage. Due to this, we would not dismiss “patient request” out of hand as in your conclusions. The dispenser, we are sure is well aware of their responsibilities and even some clinical protocols advocate “patient request” (http://www.ashfordstpeters.nhs.uk/intranet/Ashford---/Publicatio/Clinical -P/Freedom-of-Information---Proto30.doc_cvt.htm). We are all aware of the dependence liability of benzodiazepines. However, it’s also clear that regular use is more associated with it. This survey, as pointed out by the authors, should have clearly differentiated between those regularly prescribed versus those administered on prn basis to make conclusions more realistic. The medical and nursing profession seems under siege at the moment and it will be unfair to add further to the pressure without a clear delineation of best practise. Dr. Mukesh Kripalani SpR Liaison Psychiatry Dr. Amanda Gash Consultant Liaison Psychiatrist Dr. Prajakta Patil ST2 Psychiatric Trainee