Changing utilization of pro re nata ('as needed') sedation in a child and adolescent psychiatric inpatient unit

Area of Science:

• Child and Adolescent Psychiatry
• Psychopharmacology
• Healthcare Quality Improvement

Background:

• Pro re nata (PRN; as-needed) sedation is frequently used in child and adolescent psychiatric inpatient settings.
• Understanding trends and influencing factors in PRN sedation use is crucial for optimizing patient care.

Purpose of the Study:

• To investigate changes in the utilization of PRN sedation over time in a child and adolescent psychiatric inpatient unit.
• To determine if observed changes in PRN sedation use correlate with shifts in patient demographics or clinical characteristics.

Main Methods:

• A retrospective chart review of 257 patient records from a child and youth mental health inpatient service across two distinct time periods (Wave I and Wave II).
• Data collection included PRN sedation prescriptions and administration, patient characteristics, and concurrent routine medication use.

Main Results:

• A significant decrease in the proportion of patients prescribed PRN sedation (70% to 54%) and administered PRN sedation (46% to 26%) was observed over time (p < 0.01).
• Chlorpromazine was the most common PRN drug in Wave I, while diazepam was most common in Wave II.
• Multivariate analysis confirmed that the reduction in PRN sedation was independent of changes in patient characteristics.

Conclusions:

• High rates of PRN sedation are not an immutable feature of child and adolescent psychiatric inpatient care and can be effectively reduced.
• The observed decrease in PRN sedation utilization was not linked to changes in the patient population.
• Further research into treatment outcomes is necessary to refine and optimize the use of PRN sedation in pediatric mental health settings.