PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, VOL. 5: 377-384 (1996) ORIGINAL REPORT A zyxwv 1-Year Study of Drug Prescriptions and Adverse Drug Reactions in Psychiatric Hospital Practice MARC0 COSENTINO MD', OLIVIA LEON1 MD', LAURA RISPOLI MD2, CARL0 PELLEGRINI MDZ, LUCIO FINAVERA MD2, SERGIO LECCHINI MD' AND GIANMARIO FRIGO MD' zyxw 'Department zyxwvutsrqp of Internal Medicine and Therapeutics, zyxwvuts II Faculty of Medicine, University of Pavia. Varese, Italy: zy ' Ps-ychiatric Unit, USSL I ~ Varese, Italy SUMMARY Drug prescribing habits and adverse drug reaction occurrence were investigated in a psychiatric hospital ward for chronic resident patients, and the usefulness of a drug prescription and adverse event (AE) routine monitoring programme in this setting was assessed. A computerized data base was established and updated bimonthly with clinical data concerning each patient. In particular, information about drug prescriptions was routinely obtained from the clinical records, stored in the data base and periodically retrieved and analysed. The ward doctors were required to report on a form the AEs, which were subsequently examined by a panel of clinical pharmacologists and hospital consultants, to assess their relationship with drug treatments. Moreover, the data base was periodically scrutinized, to search for further AEs. Drug prescription monitoring, besides providing valuable information about drug utilization, allowed identification of some questionable issues (e.g. polypharmacy, low frequency of treatment revisions). The AE monitoring system proved to be effective and the participation of the ward doctors was satisfactory. It is concluded that in this psychiatric hospital setting a drug prescription and AE routine monitoring programme can provide useful information and promote improvement of the quality of care. zyxwvuts KEY WORDS - drug surveillance; drug utilization; adverse events; adverse drug reactions; psychiatric hospitals INTRODUCTION Hospital-based drug surveillance programmes, besides providing valuable information about drug utilization and effects, are important constituents of quality assurance monitoring' and can be useful instruments to promote self-audit and continuin education enhancement among the hospital staff. Moreover, the widely recognized limitations of pre-marketing drug te~ting,~ as also indicated by the series of major drug-related adverse events (adverse drug reactions, ADRs) reported during the last few decades, has stimulated the implemen- 9 Addressee for correspondence: Marco Cosentino, Department of Internal Medicine and Therapeutics, I1 Faculty of Medicine, University of Pavia, Via Ottorino Rossi n.9, zyxwvuts 1-21100 Varese VA, Italy, tel: 39 332 81 1601, fax: 39 332 265586. tation of hospital-based programmes for the detection and evaluation of ADRs. These pro- grammes should always be planned to ensure adequate levels of hospital care, particularly in those settings where drug-related problems are more likely to take place. In psychiatric hospital practice, surveys of drug utilization have generally raised concerns about psychotropic drug prescribing habits, e.g. poly- pharmacy, failure to adhere to recommended pharmacotherapeutic guidelines, and, usually, inadequate review of prescription^.^-'^ Further- more, in spite of the increasing use of psychotropic drugs, the occurrence of ADRs in psychiatric inpatients has seldom been inve~tigated.~,'~-'~ Italian psychiatric practice was substantially modified from 1978 onwards, after the psychiatric reform act.20 In particular, admissions to chronic CCC 1053-8569/96/060377-08 zyxwvut 0 1996 by John Wiley & Sons, Ltd. Received 15 September 1995 Accepted 4 July 1996