Discontinuing the Use of PRN Intramuscular Medication for Agitation in an Acute Psychiatric Hospital

• Published in: Psychiatric quarterly Vol. 87; no. 1; pp. 25 - 29
• Main Authors: Hayes, Ariel, Russ, Mark J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2016; Springer Nature B.V
• Subjects: Acute; Acute services; Administration, Oral; Adult; Aggressiveness; Agitation; Assaults; Chart reviews; Diphenhydramine - administration & dosage; Diphenhydramine - therapeutic use; Drug Utilization - statistics & numerical data; Drug Utilization - trends; Drugs; Female; Haloperidol - administration & dosage; Haloperidol - therapeutic use; Hospitalization; Hospitals, Psychiatric; Humans; Injections, Intramuscular; Lorazepam - administration & dosage; Lorazepam - therapeutic use; Male; Medicine; Medicine & Public Health; Mental disorders; Mental health; Middle Aged; Original Paper; Patient Safety - statistics & numerical data; Psychiatry; Psychomotor Agitation - drug therapy; Psychotropic drugs; Public Health; Retrospective Studies; Safety; Social isolation; Sociology; Studies; Young Adult; New York; United States > US; PRN medication; Inpatient psychiatry; Agitation; Aggression
• ISSN: 0033-2720; 1573-6709
• DOI: 10.1007/s11126-015-9359-1

This study examined the impact of eliminating intramuscular PRN medication for agitation on patient and staff safety in an acute psychiatric inpatient setting. The current retrospective chart review investigated the use of PRN medications (oral and intramuscular) to treat acute agitation, including aggression, and related outcomes before and after a mandated change in PRN practice that required real time physician input before administration of intramuscular medications. The use of both oral and intramuscular PRN medications dramatically decreased following implementation of the mandated change in practice. In particular, the use of intramuscular PRNs for agitation decreased by about half. Despite this decrease, the assault rate in the hospital was unchanged, and the utilization of restraint and seclusion continued to decrease. It is possible to reduce the utilization of PRN medications for agitation without broadly compromising safety on acute care psychiatric inpatient units.