Quality standard

Quality statement 4: Pharmacological interventions

Quality statement 4: Pharmacological interventions

Quality statement

People with borderline or antisocial personality disorders are prescribed antipsychotic or sedative medication only for short‑term crisis management or treatment of comorbid conditions.

Rationale

No drugs have established efficacy in treating or managing borderline or antisocial personality disorder. However, antipsychotic and sedative medication can sometimes be helpful in short‑term management of crisis (the duration of treatment should be no longer than 1 week) or treatment of comorbid conditions.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements to ensure that people with borderline or antisocial personality disorder are prescribed antipsychotic or sedative medication only for short‑term crisis management or treatment of comorbid conditions.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example care protocols.

b) Evidence of local arrangements to ensure that when people with borderline or antisocial personality disorder are prescribed antipsychotic or sedative medication, there is a record of the reason for prescribing the medication and the duration of the treatment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example care protocols.

Process

a) Proportion of people with borderline or antisocial personality disorder prescribed antipsychotic or sedative medication in a crisis or to treat comorbid conditions.

Numerator – the number in the denominator who were prescribed the antipsychotic or sedative medication in a crisis or to treat comorbid conditions.

Denominator – the number of people with borderline or antisocial personality disorder prescribed antipsychotic or sedative medication.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

b) Proportion of people with borderline or antisocial personality disorder prescribed antipsychotic or sedative medication in a crisis and who had it prescribed for no longer than a week.

Numerator – the number in the denominator prescribed antipsychotic or sedative medication for no longer than a week.

Denominator – the number of people with borderline or antisocial personality disorder prescribed antipsychotic or sedative medication in a crisis.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome measure

Antipsychotic and sedative medication prescribing rates.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (GPs and mental health trusts) ensure that staff only prescribe antipsychotic or sedative medication for people with borderline or antisocial personality disorder for short‑term crisis management or treatment of comorbid conditions.

Healthcare professionals only prescribe antipsychotic or sedative medication for people with borderline or antisocial personality disorder for short‑term crisis management or treatment of comorbid conditions.

Commissioners commission services that only prescribe antipsychotic or sedative medication for people with borderline or antisocial personality disorder for short‑term crisis management or treatment of comorbid conditions.

People with borderline or antisocial personality disorder are only prescribed antipsychotic or sedative medication for a short time if they have a crisis or if they have another condition that needs that medication.

Source guidance

Definitions of terms used in this quality statement

Short‑term crisis management

Using sedative or antipsychotic medication for short‑term crisis management means using it cautiously in a crisis as part of the overall treatment plan for people with borderline or antisocial personality disorder. The duration of treatment should be agreed with the person, but should be no longer than 1 week. [NICE's guideline on borderline personality disorder]

Crisis may be suicidal behaviour or intention, panic attacks or extreme anxiety, psychotic episodes, or behaviour that seems out of control, or irrational and likely to endanger the person or others. [Department of Health Mental health crisis care concordat (2014) and expert opinion]