Characterization of Psychotropic PRN Medications in a Canadian Psychiatric Intensive Care Unit
Characterization of Psychotropic PRN Medications in a Canadian Psychiatric Intensive Care Unit
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DOI：
10.1177/1078390321994668
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发表时间：
2021-06-10
影响因子：
2
通讯作者：
McGloin, Rumi
中科院分区：
文献类型：
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作者：
Casol, Marina;Tong, Angela;McGloin, Rumi
目的：Pro re nata (PRN) 抗精神病药和苯二氮卓类药物通常用于快速稳定急性激越患者的情绪。尽管 PRN 药物在精神卫生单位中广泛使用，但支持疗效和安全性的主要文献很少，并且没有单一的普遍接受的实践指南。如果使用不当，PRN 精神药物有可能造成不良影响。目的：我们的目标是描述精神科重症监护病房中 PRN 精神药物的处方、给药和记录实践。方法：我们对 2018 年 6 月至 9 月期间入住 12 个床位的精神科重症监护病房的患者进行了回顾性图表审查。所有 PRN 抗精神病药物和苯二氮卓类药物的处方、给药、记录实践和记录对每个订单和患者尝试的非药物策略进行了评估。采用描述性统计分析数据。结果：对 32 名患者共 123 份医生处方和 1,179 次抗精神病药物和苯二氮卓类药物 PRN 给药进行了回顾。在总给药次数中，720 次（61%）是与至少两种精神药物的组合。 41 例 (33%) 医生的医嘱有规定的适应症，559 例 (47%) 患者在 PRN 给药前尝试过非药物方法。 8 名患者 (25%) 接受了 PRN 抗精神病药物治疗，超出了每日最大剂量。三种不良药物反应归因于 PRN 给药。结论：我们确定的改进领域包括记录 PRN 给药有效性的实践、包含明确适应症和 24 小时最大限制内剂量的处方，以及所使用的非药物方法的记录。
OBJECTIVE:Pro re nata (PRN) antipsychotics and benzodiazepines are routinely used for the rapid stabilization of acutely agitated patients. Despite the popular use of PRN medications in mental health units, primary literature supporting efficacy and safety is poor, and there is no single universally accepted practice guideline. PRN psychotropic medications have the potential to cause adverse effects when used inappropriately.AIMS:Our objective was to characterize the prescribing, administration, and documentation practices of PRN psychotropic medications in a psychiatric intensive care unit.METHODS:We conducted a retrospective chart review of patients admitted to a 12-bed psychiatric intensive care unit between June and September 2018. All PRN antipsychotic and benzodiazepine orders, administrations, documentation practices, and attempted nonpharmacological strategies were assessed for each order and patient. Descriptive statistics were used to analyze data.RESULTS:Thirty-two patients with a total of 123 physicians' orders and 1,179 PRN administrations of antipsychotics and benzodiazepines were reviewed. Of the total administrations, 720 (61%) were combinations with at least two psychotropic agents. Forty-one (33%) physicians' orders had a prescribed indication, and 559 (47%) administrations had an attempted nonpharmacological method prior to PRN administration. Eight patients (25%) had antipsychotic PRN orders, which exceeded the total daily maximum dose. Three adverse drug effects were attributed to PRN administration.CONCLUSIONS:Areas of improvement that we identified included documentation practices of effectiveness of administered PRNs, prescriptions to include clear indications and dosage within the 24-hour maximum limits, and documentation of nonpharmacological methods utilized.