Abstract
The objective of this prospective study was to assess patient exposure to the psychiatric use of unscheduled medications at all nine Pennsylvania state hospitals and to unify practice guidelines in this regard. In August 2004, a decision was made to discontinue the use of p.r.n. orders for psychiatric indications. All unscheduled medications, (p.r.n. and STAT physician’s order) administered for psychiatric indications were entered into a uniform database. A total of 46,913 unscheduled medications were administered to people served in the hospital system throughout this 15 month study. During March 2004, 87.7 unscheduled medications per 1,000 days-of-care were administered in the hospital system. During the last month of this study, May 2005, this rate had decreased to 17 per 1,000 days-of-care. Many hospital safety measures significantly improved as a result of this change. Cessation of p.r.n. medication use for psychiatric indications has significantly decreased patient exposure to unnecessary psychotropic medications and has resulted in a safer hospital system.
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Acknowledgements
The authors wish to recognize the work of William H. Steinmetz, BS, for his invaluable assistance with this project and the contributions of Donna Ashbridge, MS, RN and Debra Boyd, M.Ed. The authors also thank the Honorable Estelle B. Richman, MS, Secretary, Pennsylvania Department of Public Welfare, Joan L. Erney, JD, Deputy Secretary, Office of Mental Health & Substance Abuse Services for their support of this transformational initiative. Finally, the authors gratefully acknowledge the work and vision of Richard M. O’Dea, MS, RN.
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Smith, G.M., Davis, R.H., Altenor, A. et al. Psychiatric Use of Unscheduled Medications in the Pennsylvania State Hospital System: Effects of Discontinuing the Use of P.R.N. Orders. Community Ment Health J 44, 261–270 (2008). https://doi.org/10.1007/s10597-008-9126-y
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DOI: https://doi.org/10.1007/s10597-008-9126-y