Changing prescribing practice for rapid tranquillization – a quality improvement project based on the Plan-Do-Study-Act method
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Changing prescribing practice for rapid tranquillization – a quality improvement project based on the Plan-Do-Study-Act method. / Baandrup, Lone; Dons, Anne Mette; Bartholdy, Katja Vu; Holm, Katrine Overballe; Hageman, Ida.
In: Social Psychiatry and Psychiatric Epidemiology, Vol. 59, No. 5, 2024, p. 781-788.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Changing prescribing practice for rapid tranquillization – a quality improvement project based on the Plan-Do-Study-Act method
AU - Baandrup, Lone
AU - Dons, Anne Mette
AU - Bartholdy, Katja Vu
AU - Holm, Katrine Overballe
AU - Hageman, Ida
N1 - Publisher Copyright: © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
PY - 2024
Y1 - 2024
N2 - Purpose: It is unclear how the evidence from clinical trials best translates into complex clinical settings. The aim of this quality improvement (QI) project was to change prescribing practice for rapid tranquillization in inpatient mental health care services examining the effectiveness of the Plan-Do-Study-Act (PDSA) method. Methods: A prospective QI project was conducted to ensure that intramuscular (IM) diazepam was substituted with IM lorazepam for benzodiazepine rapid tranquillization in inpatient mental health care. We monitored the prescription and administration of medication for rapid tranquillization before (N = 371), during (N = 1130) and after (N = 364) the QI intervention. Seven iterative PDSA cycles with a multiple-component intervention approach were conducted to gradually turn the prescribing practice in the desired direction. Simultaneously, a standard monitoring regimen was introduced to ensure patient safety. Results: Lorazepam administrations gradually replaced diazepam during the intervention period which was sustained post-intervention where lorazepam comprised 96% of benzodiazepine administrations for rapid tranquillization. The mean dose of benzodiazepine administered remained stable from pre (14.40 mg diazepam equivalents) to post (14.61 mg) intervention phase. Close to full compliance (> 80%) with vital signs monitoring was achieved by the end of the observation period. Conclusion: It was possible to increase the quality of treatment of acute agitation in a large inpatient mental health care setting using a stepwise approach based on iterative PDSA cycles and continuous data feedback. This approach might be valuable in other prescribing practice scenarios with feedback from local stakeholders and opinion leaders.
AB - Purpose: It is unclear how the evidence from clinical trials best translates into complex clinical settings. The aim of this quality improvement (QI) project was to change prescribing practice for rapid tranquillization in inpatient mental health care services examining the effectiveness of the Plan-Do-Study-Act (PDSA) method. Methods: A prospective QI project was conducted to ensure that intramuscular (IM) diazepam was substituted with IM lorazepam for benzodiazepine rapid tranquillization in inpatient mental health care. We monitored the prescription and administration of medication for rapid tranquillization before (N = 371), during (N = 1130) and after (N = 364) the QI intervention. Seven iterative PDSA cycles with a multiple-component intervention approach were conducted to gradually turn the prescribing practice in the desired direction. Simultaneously, a standard monitoring regimen was introduced to ensure patient safety. Results: Lorazepam administrations gradually replaced diazepam during the intervention period which was sustained post-intervention where lorazepam comprised 96% of benzodiazepine administrations for rapid tranquillization. The mean dose of benzodiazepine administered remained stable from pre (14.40 mg diazepam equivalents) to post (14.61 mg) intervention phase. Close to full compliance (> 80%) with vital signs monitoring was achieved by the end of the observation period. Conclusion: It was possible to increase the quality of treatment of acute agitation in a large inpatient mental health care setting using a stepwise approach based on iterative PDSA cycles and continuous data feedback. This approach might be valuable in other prescribing practice scenarios with feedback from local stakeholders and opinion leaders.
KW - Continuous improvement
KW - Mental health care
KW - Patient safety
KW - Psychiatry
KW - Quality improvement
U2 - 10.1007/s00127-023-02461-9
DO - 10.1007/s00127-023-02461-9
M3 - Journal article
C2 - 36943451
AN - SCOPUS:85150489259
VL - 59
SP - 781
EP - 788
JO - Social Psychiatry and Psychiatric Epidemiology
JF - Social Psychiatry and Psychiatric Epidemiology
SN - 0933-7954
IS - 5
ER -
ID: 370818334