Administered antipsychotic pro re nata medications in psychiatric inpatients. Pre- and post-accreditation comparison

To investigate whether the mental health accreditation program drives improvements in the clinical practice of giving pro re nata (PRN) antipsychotic medications for psychiatric inpatients.

This study was conducted in October 2012, a record-based pre-post assessment design in psychiatric inpatient wards at King Khalid University Hospital, Riyadh, Saudi Arabia. Data collected from a 12-month pre-accreditation period (July 2009 to June 2010) was compared with those from a 12-month post-accreditation period (July 2011 to June 2012). The collected data identified demographics, diagnosis, number of PRN antipsychotic medications administered per patient, and indications for use.

There were 177 patients during the pre-accreditation period, and 182 patients during the post-accreditation period. Before accreditation, 87% of patients were administered PRN antipsychotics and the average number of PRN antipsychotic administrations per patient was 12.10+/-7.0 compared with 81% of patients being administered 7.47+/-3.2 PRN antipsychotic medications per patient post-accreditation. Prior to accreditation, a high number of PRN antipsychotic medications were administered to patients with no specified indications (rs=0.698; p<0.001). During the post-accreditation period, the corresponding correlation coefficients significantly declined to rs=0.465; p<0.001.

Implementation of clinical practice guidelines in psychiatric inpatients significantly reduces the frequency of PRN antipsychotic medications and enhances patient safety.