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Knowsley Local Medication Management Policies

General Principles of Prescribing Antipsychotics

  1. The lowest possible does of a medicine should be used.
    • Initiate at the lowest effective dose
    • Oral: Increase dose after 2 weeks if the patient shows no or poor response
    • Depot: Plama levels rise for 6-12 weeks after initiation. Do not increase dose during this period
  2. Antipsychotic drugs, either typical or atypical should not be prescribed together
    • More than one antipsychotic should only be used rarely, where a single antipsychotic is inadequate.
    • The effect of polypharmacy should be clearly documented and if there is no benefit, revert to one antipsychotic.
  3. If a patient has had two antipsychotics (including one atypical) each for 6-8 weeks without improvement, consider clozapine
  4. If a patient is currently achieving good control with a typical antipsychotic and does not have unacceptable side-effects, they should not be changed to a newer atypical
  5. Responses to medication should be assessed using validated rating scales and recorded in patient notes

Rapid Tranquillisation Protocol 5 Boroughs, St Helens and Knowsley

Rapid Tranquilisation

St Helens and Knowsley NHS Trust

SHARED CARE GUIDELINES FOR ATYPICAL ANTIPSYCHOTICS

  • All atypical antipsychotics will be initiated by the psychiatrist
  • Prescribing of clozapine will remain with the consultants in all cases
  • After a period of 6 months, where there is proven therapeutic benefit and mental health is stable, the CMHT may wish to transfer prescribing to the GP
  • A patient will only be transferred to the GP once the GP has agreed in each case
  • The hospital recognises that a GP retains the right to refuse to share care. In this case, the consultant will retain total clinical responsibility for the patient, including prescribing.

Consultant responsibilities

  • All treatment to be notified to GPs after assessments
  • The GP will be sent a copy of the shared care guidelines, the relevant drug information leaflet and be invited to undertake the prescribing responsibility.
  • The consultant will take responsibility for continued review of the patient. Monitoring may be by the CMHT worker
  • The GP will be informed in writing of any changes to treatment within 1 week of appointment.
  • If treatment is outside licensed dosage, prescribing responsibility will be returned to the consultant.

GP responsibilities

  • The GP will ensure adequate knowledge of treatment prior to taking clinical responsibility
  • The GP will issue a prescription according to the written instructions of the consultant
  • The GP will report any problems or adverse effects of therapy to the consultant
  • The GP will inform the consultant of any treatment prescribed for the patient which could affect the psychotropic treatment

Availability of support and advice

Consultant
Senior Registrar
Hospital pharmacist
Out-of-hours contact
LB August 1999