Changing prescribing practice for rapid tranquillization-a quality improvement project based on the Plan-Do-Study-Act method.
Continuous improvement
Mental health care
Patient safety
Psychiatry
Quality improvement
Journal
Social psychiatry and psychiatric epidemiology
ISSN: 1433-9285
Titre abrégé: Soc Psychiatry Psychiatr Epidemiol
Pays: Germany
ID NLM: 8804358
Informations de publication
Date de publication:
21 Mar 2023
21 Mar 2023
Historique:
received:
14
08
2022
accepted:
08
03
2023
pubmed:
22
3
2023
medline:
22
3
2023
entrez:
21
3
2023
Statut:
aheadofprint
Résumé
It is unclear how the evidence from clinical trials best translates into complex clinical settings. The aim of this quality improvement (QI) project was to change prescribing practice for rapid tranquillization in inpatient mental health care services examining the effectiveness of the Plan-Do-Study-Act (PDSA) method. A prospective QI project was conducted to ensure that intramuscular (IM) diazepam was substituted with IM lorazepam for benzodiazepine rapid tranquillization in inpatient mental health care. We monitored the prescription and administration of medication for rapid tranquillization before (N = 371), during (N = 1130) and after (N = 364) the QI intervention. Seven iterative PDSA cycles with a multiple-component intervention approach were conducted to gradually turn the prescribing practice in the desired direction. Simultaneously, a standard monitoring regimen was introduced to ensure patient safety. Lorazepam administrations gradually replaced diazepam during the intervention period which was sustained post-intervention where lorazepam comprised 96% of benzodiazepine administrations for rapid tranquillization. The mean dose of benzodiazepine administered remained stable from pre (14.40 mg diazepam equivalents) to post (14.61 mg) intervention phase. Close to full compliance (> 80%) with vital signs monitoring was achieved by the end of the observation period. It was possible to increase the quality of treatment of acute agitation in a large inpatient mental health care setting using a stepwise approach based on iterative PDSA cycles and continuous data feedback. This approach might be valuable in other prescribing practice scenarios with feedback from local stakeholders and opinion leaders.
Identifiants
pubmed: 36943451
doi: 10.1007/s00127-023-02461-9
pii: 10.1007/s00127-023-02461-9
pmc: PMC10029773
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
Zaman H, Sampson SJ, Beck AL, Sharma T, Clay FJ, Spyridi S, Zhao S, Gillies D (2017) Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev 12:Cd003079. https://doi.org/10.1002/14651858
doi: 10.1002/14651858
pubmed: 29219171
Kim HK, Leonard JB, Corwell BN, Connors NJ (2021) Safety and efficacy of pharmacologic agents used for rapid tranquilization of emergency department patients with acute agitation or excited delirium. Expert Opin Drug Saf 20(2):123–138. https://doi.org/10.1080/14740338.2021.1865911
doi: 10.1080/14740338.2021.1865911
pubmed: 33327811
National Collaborating Centre for Mental Health (2015). National Institute for Health and Care Excellence: Clinical Guidelines. Violence and Aggression: Short-Term Management in Mental Health, Health and Community Settings: Updated edition. London: British Psychological Society. The British Psychological Society & The Royal College of Psychiatrists
NHS Foundation Trust (2021) Rapid tranquillisation (RT) policy (including prescribing, post administration monitoring and remedial measures)-CLIN-0014–01-v8.2
Wilson MP, Pepper D, Currier GW, Holloman GH, Feifel D (2012) The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med 13(1):26–34. https://doi.org/10.5811/westjem.2011.9.6866
doi: 10.5811/westjem.2011.9.6866
pubmed: 22461918
pmcid: 3298219
Rangachari P, Rissing P, Rethemeyer K (2013) Awareness of evidence-based practices alone does not translate to implementation: insights from implementation research. Qual Manag Health Care 22(2):117–125. https://doi.org/10.1097/QMH.0b013e31828bc21d
doi: 10.1097/QMH.0b013e31828bc21d
pubmed: 23542366
Tabak RG, Khoong EC, Chambers DA, Brownson RC (2012) Bridging research and practice: models for dissemination and implementation research. Am J Prev Med 43(3):337–350. https://doi.org/10.1016/j.amepre.2012.05.024
doi: 10.1016/j.amepre.2012.05.024
pubmed: 22898128
pmcid: 3592983
Crisp H (2015) Building the field of improvement science. Lancet 26(385 Suppl 1):S4-5. https://doi.org/10.1016/S0140-6736(15)60320-8
doi: 10.1016/S0140-6736(15)60320-8
Marshall M, Pronovost P, Dixon-Woods M (2013) Promotion of improvement as a science. Lancet 381(9864):419–421. https://doi.org/10.1016/S0140-6736(12)61850-9
doi: 10.1016/S0140-6736(12)61850-9
pubmed: 23374480
Knudsen SV, Laursen HVB, Johnsen SP, Bartels PD, Ehlers LH, Mainz J (2019) Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC Health Serv Res 19(1):683. https://doi.org/10.1186/s12913-019-4482-6
doi: 10.1186/s12913-019-4482-6
pubmed: 31585540
pmcid: 6778385
Ross S, Naylor C. (2017) Quality improvement in mental health. www.kingsfund.org.uk ed: King's Fund
Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D, Reed JE (2014) Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Qual Saf 23(4):290–298. https://doi.org/10.1136/bmjqs-2013-001862
doi: 10.1136/bmjqs-2013-001862
pubmed: 24025320
Etchells E, Ho M, Shojania KG (2016) Value of small sample sizes in rapid-cycle quality improvement projects. BMJ Qual Saf 25(3):202–206. https://doi.org/10.1136/bmjqs-2015-005094
doi: 10.1136/bmjqs-2015-005094
pubmed: 26717989
Portela MC, Pronovost PJ, Woodcock T, Carter P, Dixon-Woods M (2015) How to study improvement interventions: a brief overview of possible study types. BMJ Qual Saf 24(5):325–336. https://doi.org/10.1136/bmjqs-2014-003620
doi: 10.1136/bmjqs-2014-003620
pubmed: 25810415
pmcid: 4413733
Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D (2016) SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 25(12):986–992. https://doi.org/10.1136/bmjqs-2015-004411
doi: 10.1136/bmjqs-2015-004411
pubmed: 26369893
Kalassian KG, Dremsizov T, Angus DC (2002) Translating research evidence into clinical practice: new challenges for critical care. Crit Care 6(1):11–14. https://doi.org/10.1186/cc1446
doi: 10.1186/cc1446
pubmed: 11940259
pmcid: 137390
Wong BM, Sullivan GM (2016) How to write up your quality improvement initiatives for publication. J Grad Med Educ 8(2):128–133. https://doi.org/10.4300/JGME-D-16-00086.1
doi: 10.4300/JGME-D-16-00086.1
pubmed: 27168874
pmcid: 4857497
Hallam CRA, Contreras C (2018) Lean healthcare: scale, scope and sustainability. Int J Health Care Qual Assur 31(7):684–696. https://doi.org/10.1108/IJHCQA-02-2017-0023
doi: 10.1108/IJHCQA-02-2017-0023
pubmed: 30354875
Aij KH, Teunissen M (2017) Lean leadership attributes: a systematic review of the literature. J Health Organ Manag 31(7–8):713–729. https://doi.org/10.1108/JHOM-12-2016-0245
doi: 10.1108/JHOM-12-2016-0245
pubmed: 29187082
pmcid: 5868554
Garcia CA, Bhatnagar M, Rodenbach R, Chu E, Marks S, Graham-Pardus A, Kriner J, Winfield M et al (2019) Standardization of inpatient CPR status discussions and documentation within the division of hematology-oncology at UPMC shadyside: results from PDSA cycles 1 and 2. J Oncol Pract 15(8):e746–e754. https://doi.org/10.1200/JOP.18.00416
doi: 10.1200/JOP.18.00416
pubmed: 31206337
Stocki D, McDonnell C, Wong G, Kotzer G, Shackell K, Campbell F (2018) Knowledge translation and process improvement interventions increased pain assessment documentation in a large quaternary paediatric post-anaesthesia care unit. BMJ Open Qual 7(3):e000319. https://doi.org/10.1136/bmjoq-2018-000319
doi: 10.1136/bmjoq-2018-000319
pubmed: 30167475
pmcid: 6112407
Ross S, Naylor C (2017) Quality improvement in mental health. Ed: King’s Fund. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Quality_improvement_mental_health_Kings_Fund_July_2017_0.pdf
Kilbourne AM, Beck K, Spaeth-Rublee B, Ramanui P, O’Brien RW, Tomoyasu N, Pincus HA (2018) Measuring and improving the quality of mental health care: a global perspective. World Psych 27(1):30–38. https://doi.org/10.1002/wps.20482
doi: 10.1002/wps.20482
Abdallah N, Conn R, Latif Marini A (2016) Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications. BMJ Qual Improv Rep 5(1):u210300.w4189. https://doi.org/10.1136/bmjquality.u210300.w4189
doi: 10.1136/bmjquality.u210300.w4189
pubmed: 27559474
pmcid: 4994095
Chowdhury P, Tari A, Hill O, Shah A (2020) To improve the communication between a community mental health team and its service users, their families and carers. BMJ Open Qual 9(4):e000914. https://doi.org/10.1136/bmjoq-2020-000914
doi: 10.1136/bmjoq-2020-000914
pubmed: 33154096
pmcid: 7646348
Davidoff F, Dixon-Woods M, Leviton L, Michie S (2015) Demystifying theory and its use in improvement. BMJ Qual Saf 24(3):228–238. https://doi.org/10.1136/bmjqs-2014-003627
doi: 10.1136/bmjqs-2014-003627
pubmed: 25616279
pmcid: 4345989