Use of a Novel Standardized Administration Protocol Reduces Agitation Pro Re Nata (PRN) Medication Requirements: The Birmingham Agitation Management (BAM) Initiative.

Autor:	Burk BG; Department of Pharmacy, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA., Penherski P; Department of Psychiatry, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.; Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA., Snider K; Department of Regulatory Services, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA., Lewellyn L; Department of Nursing, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA., Mattox L; Department of Nursing, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA., Polancich S; Department of Regulatory Services, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.; Department of Nursing, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.; School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA., Fargason R; Department of Psychiatry, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.; Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA., Waggoner B; Department of Clinical Informatics, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA., Caine E; Department of Hospital Administration, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA., Hand W; Department of Nursing, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA., Eagleson RM; Department of Nursing, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA., Birur B; Department of Psychiatry, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.; Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
Jazyk:	angličtina
Zdroj:	The Annals of pharmacotherapy [Ann Pharmacother] 2023 Apr; Vol. 57 (4), pp. 397-407. Date of Electronic Publication: 2022 Aug 11.
DOI:	10.1177/10600280221117813
Abstrakt:	Background: Agitation management is a principal challenge on inpatient psychiatric units. Overreliance on common prescribing strategies of pro re nata (PRN) medication administration is problematic, given the tendencies to have overlapping or unclear indications. Objective: Piloted project to determine whether a standardized protocol for agitation intervention may reduce PRN medication administration. Methods: The Birmingham Agitation Management (BAM) interdisciplinary team uniquely connected the Brøset Violence Checklist (BVC) for assessment of agitation severity to a standardized PRN medication order set. Nurses on the piloted unit were trained on how to score the BVC and administer medications. Patients were assessed by the BVC every 4 hours and, based on their score, would receive no medication, low-dose benzodiazepine, high-dose benzodiazepine, or high-dose benzodiazepine plus antipsychotic. The primary end point compared the number of PRNs administered after novel protocol implementation with a retrospective cohort. Secondary measures included analysis of medication-related effects, seclusion, and physical restraint rates. Results: 377 patients were included in the final analyses (184 pre-BAM, 193 BAM intervention group). No significant differences were seen in patient characteristics between groups. The total number of PRNs administered decreased by 42.5%, with both the mean and median number of administrations decreasing significantly (95% confidence interval [CI] = [1.68-5.75]; P < 0.001). A trend was noted between the number of PRNs administered and seclusion rates, but did not reach statistical significance (95% CI = [-7.28 to 60.31]; P = 0.124). Conclusions: In seemingly the first initiative of its kind, we found that a standardized agitation management protocol can help decrease the total number of PRN administrations for agitation without worsening of restraint rates and may possibly reduce the risk of adverse effects. These results require validation in specific, larger populations.
Databáze:	MEDLINE
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