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Aims and MethodThis study examines prescription and monitoring of lorazepam on three acute adult psychiatric wards at a university teaching hospital. Retrospective data from 102 consecutive in-patients were analysed.ResultsThere were 83 patients (81.4%) who were prescribed lorazepam, however 45 of these (46%) were never administered it. Indication for lorazepam prescription was documented by the doctor in 35 patients (42.2%). Administration by nursing staff was documented in the medical notes on 86 occasions (60.0%) and on 32 of these (37.0%) the indication was unclear. On 21 occasions (14.7%) more than 2 mg was given; 13.7% of prescriptions were not reviewed and 64% of those reviewed after more than 4 weeks.Clinical ImplicationsLorazepam was overprescribed and inadequately monitored, which may increase the risk of dependence.

The introduction of the domiciliary visit has in many cases brought about a closer liaison between the general practitioner and the specialist. Visits to the patient's home and to the practitioner's surgery, and close acquaintance with the social structure of the district in which the practice lies, are of particular value when the specialty concerned is psychiatry. Since 1949 a relationship has developed between a group of four partners in a general practice and a psychiatrist which is believed to be mutually beneficial. We shall attempt to describe some of the experiences arising from this association.

SummaryRecent surveys have highlighted widespread criticisms of the use of workplace-based assessments (WPBAs) in psychiatric training. We describe our systematic review of psychiatric WPBAs, including a ‘surgical dissection’ of their format and process. From our review, we identified seven overarching WPBA themes, and have drawn on these to make further recommendations to strengthen the wider acceptability of WPBAs in psychiatric settings. We hope this will encourage further debate on ways of improving these tools, rather than them becoming side-lined as ‘top-down’ tick-box exercises.