Prescribing guideline for people with a first episode of psychosis
Outcomes and learning
Outcomes
Through presentations and consultations both within the trust and externally, we were able to produce prescribing guidelines that clearly show NICE guidance, as well as providing prescribers with evidence-based treatment options. This means that patients' conditions are correctly assessed (including a treatment-free period). And where appropriate, they are offered low-dose, second-generation antipsychotics, with specific recommendations made, which builds on NICE guidance.
Trust prescribing information showed that prescribing for antipsychotics was on a downward trend overall. Second-generation antipsychotics are now primarily prescribed. There has been a move away from prescribing antipsychotics such as olanzapine, with its associated long-term detrimental cardiometabolic consequences for patients. Medication is increasingly given a fair trial. Physical health monitoring is also improving.
People have welcomed more choice in their treatment options, and we have received excellent feedback about the information provided about the different medication options available. With patients more involved in prescribing decisions, adherence has increased, and stopping medication because of side effects has reduced. As a result, it is likely that this will reduce rates of relapse, and so reduce time spent in hospital. Not only have the prescribing guidelines benefited patients, but prescribers across the trust have welcomed these guidelines. In addition, other trusts are also adopting the guidelines.
Learning
The key to the success of our project has been the involvement of all prescribers through an extensive consultation period. For the prescribing guidelines to be adopted, all prescribers needed to be made aware of the benefits to patients and the latest evidence-based treatments.
The involvement of our trust medicines optimisation group and trust-wide medical advisory group, and the endorsement of our medical director, has been key. Close working relationships with inpatient colleagues and prescribers across other mental health teams has been essential in taking this forward, as prescribing is often started by them. Teaching and training have been helpful, with discussion and early identification of any issues.
A prescribing guideline for all people experiencing a first episode psychosis cannot be too prescriptive, but a fine balance can be achieved to ensure the best possible outcomes for this vulnerable group of people.
Contact details
Dr Liz Ewins, Consultant Psychiatrist
Email: elizabethewins@nhs.net
ISBN: 978-1-4731-9428-1
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