SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA.
BMC Psychiatry. 2021 Mar 6;21(1):132. doi: 10.1186/s12888-021-03127-z.
In this quality improvement project, we set out to study the effectiveness and feasibility of using music as an adjunct or replacement for pharmacologic agitation management on an inpatient psychiatric unit. We hypothesized music intervention would not only assist in de-escalation/calming of agitated patients, but also reduce overall administration of PRN medications on the unit.
The project included 172 volunteer participants over 6 months: Three months without music available and 3 months with a music de-escalation option. During the latter period, patients were given the option of selecting a preferred music genre and provided with wireless headphones for up to 30 min. The number of as needed (PRN) medications administered for agitation and anxiety (including oral, sublingual, and intramuscular routes) was compiled from raw data using pharmacy records. Patients and nurses were provided with self-report surveys regarding the music intervention.
The average weekly PRN medication administrations decreased significantly during the 3 months with music for both haloperidol (8.46 [+/- 1.79, p < 0.05] to 5.00 [+/- 1.44, p < 0.05] administrations/week) and olanzapine (9.69 [+/- 2.32, p < 0.05] to 4.62 [+/- 1.51, p < 0.05] administrations/week), compared to the 3 months prior to music implementation. There was a non-significant increase in administration of lorazepam (3.23 [+/- 1.09, p < 0.05] to 6.38 [+/- 2.46, p < 0.05] average administrations/week). The patient survey responses were 96% positive (non-neutral; either agree or strongly agree with calming effect). Nurses agreed that the project was easy to implement; 56% agreed that music helped to calm patients down. Other exploratory outcomes included observed reductions in average length of hospital stay and number of seclusion events.
Music may play a significant role in reducing the utilization of PRN agitation medications on acute inpatient psychiatric units. More studies are needed to expand on these findings and explore the effect of PRN music on other therapeutic outcomes.
Protocol registration NCT04514432 , retrospectively registered on 08/13/2020.
在这项质量改进项目中，我们旨在研究在住院精神病病房中使用音乐作为辅助或替代药物治疗激越的有效性和可行性。我们假设音乐干预不仅可以帮助患者减轻激越，还可以减少单位内 PRN 药物的总体使用。
该项目包括 6 个月内的 172 名志愿者参与者：3 个月无音乐可用，3 个月有音乐缓解选择。在此期间，患者可以选择自己喜欢的音乐类型，并提供无线耳机，最长可达 30 分钟。使用药房记录从原始数据中编译用于治疗激越和焦虑的按需（PRN）药物的数量（包括口服、舌下和肌肉途径）。患者和护士都对音乐干预进行了自我报告调查。
在有音乐的 3 个月中，无论是氟哌啶醇（8.46 [+/-1.79，p < 0.05]至 5.00 [+/-1.44，p < 0.05]/周）还是奥氮平（9.69 [+/-2.32，p < 0.05]至 4.62 [+/-1.51，p < 0.05]/周），PRN 药物的每周给药次数均显著减少，与音乐实施前的 3 个月相比。劳拉西泮的给药量略有增加（3.23 [+/-1.09，p < 0.05]至 6.38 [+/-2.46，p < 0.05]/周）。患者调查的反馈率为 96%（非中性；同意或强烈同意镇静效果）。护士们认为该项目易于实施；56%的人同意音乐有助于使患者平静下来。其他探索性结果包括平均住院时间和隔离事件数量的减少。
音乐可能在减少急性住院精神病病房 PRN 激动药物的使用方面发挥重要作用。需要进一步的研究来扩大这些发现，并探索 PRN 音乐对其他治疗结果的影响。
方案注册 NCT04514432，于 2020 年 8 月 13 日回顾性注册。
