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Changing prescribing practice for rapid tranquillization-a quality improvement project based on the Plan-Do-Study-Act

Lone Baandrup1,2, Anne Mette Dons3, Katja Vu Bartholdy3

  • 1The Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Copenhagen, Denmark. lone.baandrup@regionh.dk.

Social Psychiatry and Psychiatric Epidemiology
|March 21, 2023
PubMed
Summary
This summary is machine-generated.

This quality improvement project successfully switched inpatient rapid tranquillization from diazepam to lorazepam using the Plan-Do-Study-Act method, improving patient care.

Keywords:
Continuous improvementMental health carePatient safetyPsychiatryQuality improvement

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Area of Science:

  • Psychiatry
  • Clinical Pharmacy
  • Quality Improvement Science

Background:

  • Translating clinical trial evidence into complex healthcare settings poses challenges.
  • Optimizing rapid tranquillization protocols in inpatient mental health is crucial for patient safety and effective treatment.

Purpose of the Study:

  • To evaluate the effectiveness of the Plan-Do-Study-Act (PDSA) method in changing prescribing practices for rapid tranquillization.
  • To transition from intramuscular (IM) diazepam to IM lorazepam for benzodiazepine rapid tranquillization in inpatient mental health care.

Main Methods:

  • A prospective quality improvement (QI) project was implemented over multiple iterative PDSA cycles.
  • Prescription and administration data for rapid tranquillization were monitored before, during, and after the intervention.
  • A multi-component intervention focused on shifting prescribing from diazepam to lorazepam, with concurrent introduction of vital signs monitoring.

Main Results:

  • Lorazepam use for rapid tranquillization increased to 96% post-intervention, replacing diazepam.
  • The average benzodiazepine dose remained stable (approx. 14.5 mg diazepam equivalents).
  • Compliance with vital signs monitoring exceeded 80% by the study's end.

Conclusions:

  • A stepwise, data-driven approach using iterative PDSA cycles effectively improved prescribing quality for acute agitation in inpatient mental health.
  • This QI methodology, incorporating stakeholder feedback, is potentially applicable to other prescribing practice changes.