Over the past decade there has been increased recognition of the dangers associated with inpatient management of diabetes insipidus (DI) and omission of desmopressin. An NHS England patient safety alert was issued in 2016 highlighting this risk.
Method: Using electronic prescribing records we reviewed all desmopressin prescriptions and omissions over a 12 month period in a large teaching hospital.
Results: Ninety-seven inpatients were prescribed 1367 doses of desmopressin during the year. The mean number of doses per patient was 14, with a range 1388 doses and a median of 2 doses.
In 69% of patients (67/97) the indication was DI. Thirty patients received desmopressin for a range of other indications including haemophilia, suspected platelet dysfunction, and urinary continence problems. 77% of all doses were prescribed on neurology and neurosurgical wards.
Overall 5% of prescribed desmopressin doses were omitted (66/1367). The rate of omission was 18% for desmopressin nasal spray and 45% for oral or injected desmopressin (Table 1).
|Prescribed doses||Doses omitted||Omission rate %|
Discussion: Desmopressin omissions occur for both legitimate reasons (e.g. hyponatraemia) and inappropriate reasons (including lack of drug availability). This study shows that the intranasal formulation is especially likely to be omitted. The reason for this is the subject of future work, but we speculate that nasal medications (along with inhalers and eye drops) may be perceived by staff as less clinically important than oral or injectable medications.