An Audit of Adherence to the Agitation and Arousal Chart on an Inpatient Child and Adolescent Psychiatric Ward

Evidence has shown that pro re nata (PRN) medications are often prescribed to manage agitation and disruptive behaviors. They require meticulous monitoring to prevent adverse effects and medication overuse. This article describes an audit that evaluated staff adherence to the use of an "agitation and arousal" chart that monitored PRN medication use on a child and adolescent psychiatric ward.

The audit was conducted using the Plan-Do-Study-Act cycle design. Results from the first cycle were analyzed and presented in multiple formats. The second cycle was undertaken 4 months later. Adherence to the chart was re-evaluated with the expected audit standard set at 100%.

Sample sizes were similar in both cycles. Across the 2 cycles, 53% to 64% of inpatients were prescribed PRN medications and required use of the chart. There was an overall improvement in staff adherence across all areas of the chart, but the expected audit standard was only achieved in "medication choice as per guideline" and "medication dose as per guideline."

The audit highlighted improved staff adherence to the expected audit standards in most areas following staff education, but the desired 100% compliance with standards in all areas was not achieved. Ongoing education and monitoring were recommended.