Casol Marina, Tong Angela, Ng Joan C Y, McGloin Rumi
Marina Casol, BSc (Pharm), ACPR, Surrey Memorial Hospital, Surrey, British Columbia, Canada.
Angela Tong, BSc (Pharm), ACPR, Surrey Memorial Hospital, Surrey, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada.
J Am Psychiatr Nurses Assoc. 2023 Mar-Apr;29(2):103-111. doi: 10.1177/1078390321994668. Epub 2021 Jun 10.
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.
Our objective was to characterize the prescribing, administration, and documentation practices of PRN psychotropic medications in a psychiatric intensive care unit.
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.
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.
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.
必要时使用的抗精神病药物和苯二氮䓬类药物通常用于急性躁动患者的快速稳定治疗。尽管必要时使用的药物在精神科病房中广泛使用，但支持其有效性和安全性的主要文献质量较差，且没有一个被普遍接受的实践指南。必要时使用的精神药物如果使用不当可能会产生不良反应。
我们的目标是描述精神科重症监护病房中必要时使用的精神药物的处方、给药和记录情况。
我们对2018年6月至9月入住一家拥有12张床位的精神科重症监护病房的患者进行了回顾性病历审查。对每份医嘱和每位患者的所有必要时使用的抗精神病药物和苯二氮䓬类药物的医嘱、给药情况、记录情况以及尝试的非药物策略进行了评估。使用描述性统计分析数据。
对32例患者进行了审查，共有123份医生医嘱以及1179次必要时使用的抗精神病药物和苯二氮䓬类药物的给药记录。在所有给药记录中，720次（61%）是与至少两种精神药物的联合使用。41份（33%）医生医嘱有规定的适应症，559次（47%）给药在必要时使用药物之前尝试了非药物方法。8例患者（25%）的必要时使用的抗精神病药物医嘱超过了每日最大剂量。有3例药物不良反应归因于必要时使用的药物给药。
我们确定的需要改进的方面包括已给药的必要时使用的药物的有效性记录、处方应包括明确的适应症和24小时最大剂量内的剂量，以及所采用的非药物方法的记录。
