Weekend Prescribing Practices and Subsequent Seclusion and Restraint in a Psychiatric Inpatient Setting

• Published in: Psychiatric services (Washington, D.C.) Vol. 61; no. 2; pp. 193 - 195
• Main Authors: Goldbloom, David Lee, Mojtabai, Ramin, Serby, Michael J
• Format: Journal Article
• Language: English
• Published: Arlington, VA American Psychiatric Association 01.02.2010; American Psychiatric Publishing, Inc
• Subjects: Academic Medical Centers; Accreditation; Adult; Alliances; Antipsychotic Agents - therapeutic use; Behavior; Biological and medical sciences; Bipolar disorder; Bipolar Disorder - drug therapy; Bipolar Disorder - epidemiology; Case-Control Studies; Confidence intervals; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Hospital systems; Hospitalization; Hospitals; Humans; Institution therapy. Inpatient treatment; Male; Medical sciences; Mental institutions; Metabolic disorders; Middle Aged; New York City; Patient Isolation - utilization; Practice Patterns, Physicians' - standards; Psychiatric Department, Hospital - standards; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotic Disorders - drug therapy; Psychotic Disorders - epidemiology; Restraint, Physical - utilization; Schizophrenia - drug therapy; Schizophrenia - epidemiology; Studies; Treatments; Utilization Review - statistics & numerical data; United States; North America; America; New York City; Mood disorder; Social environment; Human; Psychotropic; Mental health; Pharmacotherapy; Schizophrenia; Male; Hospitalization; Case control study; Epidemiology; Retrospective; Seclusion; Prevention; Treatment; Medical prescription; Mental disorder; Restraint; Early; Diagnosis; Public health
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/ps.2010.61.2.193

This case-control study examined the role of early medication management in preventing seclusion and restraint. Data were extracted from the medical records, including whether standing medication was increased, decreased, or left unchanged during the first 48 hours of hospitalization. Compared with inpatients who did not experience seclusion or restraint (N=39), those who did (N=39) were younger (p=.01) and more likely to be male (p=.023) and to have a primary discharge diagnosis of bipolar disorder, mixed or manic episode, schizophrenia, or schizoaffective disorder (p<.001). Patients whose standing medication was not changed during the first 48 hours of hospitalization had 5.5 times as many restraints as patients whose dose was increased or who received new prescriptions (p=.027). Early use of medication can reduce the incidence of seclusion and restraint among high-risk patients early in their hospitalization.