title: Discontinuing the Use of PRN Intramuscular Medication for Agitation in an Acute Psychiatric Hospital.
abstract: 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.
authors: North Shore-Long Island Jewish Health System, Manhasset, NY, 11030, USA.
authors: Ariel
authors: A
authors: Hayes
authors: Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital/Westchester Division, 21 Bloomingdale Road, White Plains, NY, 10605, USA. mjr9012@med.cornell.edu.
authors: Mark J
authors: MJ
authors: Russ
mesh_terms: D000284:Administration, Oral; D000328:Adult; D004155:Diphenhydramine / Q000008:administration & dosage / Q000627:therapeutic use; D004363:Drug Utilization / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage / Q000627:therapeutic use; D006778:Hospitals, Psychiatric; D006801:Humans; D007273:Injections, Intramuscular; D008140:Lorazepam / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000706:statistics & numerical data*; D011595:Psychomotor Agitation / Q000188:drug therapy*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D004155:Diphenhydramine; D006220:Haloperidol; D008140:Lorazepam
keywords: Aggression; Agitation; Inpatient psychiatry; PRN medication