Clinical audit of psychotropic medication use at a South African intellectual disability hospital

Abstract

Background: Individuals with intellectual disability (ID) are often prescribed psychotropic medications at disproportionately high rates, particularly for managing psychiatric symptoms or behaviours that challenge (BTC). International guidelines emphasise cautious, evidence-based use and the prioritisation of non-pharmacological interventions.
Aim: This audit evaluated prescribing practices at a specialist psychiatric hospital in South Africa to determine the extent of alignment with internationally recommended standards for psychotropic use in individuals with ID.
Setting: Outpatient department (OPD) of an advanced psychiatric care institution in Cape Town.
Methods: A retrospective folder and prescription review was conducted for 103 patients with ID who were newly referred between January 2018 and August 2019. Prescribing decisions at the first visit and 6-month follow-up were assessed against guidance from the World Psychiatric Association (WPA) and National Institute for Health and Care Excellence (NICE).
Results: Psychotropic medications were prescribed to 88% of patients. Antipsychotics were the most frequently used agents, comprising over half of all prescriptions, often for BTC in the absence of a psychotic disorder. While certain elements of guideline-based care were evident – such as use of low effective doses – gaps were noted in documentation of rationale, review scheduling, side-effect monitoring and consistent use of behavioural strategies. These areas highlight opportunities for strengthening practice.
Conclusion: This audit emphasises the complexity of psychotropic prescribing for individuals with ID and the need for structured, multidisciplinary approaches to ensure safe and appropriate medication use.
Contribution: Embedding standard protocols and regular reviews into clinical workflows may support better adherence to international best-practice standards.