Best practices: An initiative to curtail the use of antipsychotic polypharmacy in a state psychiatric hospital.

A performance improvement initiative was undertaken at a state psychiatric hospital to reduce antipsychotic polypharmacy. Data from physicians' order forms were used to document the prescribing practices of 14 psychiatrists in November 2001 and in August 2002. After baseline data were collected, the chief of psychiatry met with each psychiatrist to compare his or her prescribing data with data of anonymous peers. The chief also asked all psychiatrists to decrease antipsychotic polypharmacy by at least 10 percent. Antipsychotic polypharmacy fell significantly--from 42 percent of patients treated with antipsychotics in November 2001 to 31 percent in August 2002. Higher utilizers of polypharmacy at baseline continued to be high utilizers at follow-up. Less antipsychotic polypharmacy was not associated with more use of other psychotropic medications. The findings suggest that initiatives that involve the focused attention of leadership and only a modest investment of effort can result in significant change in prescribing practices in a state hospital.