Administered antipsychotic pro re nata medications in psychiatric inpatients. Pre- and post-accreditation comparison

ABSTRACT

To investigate whether the mental health accreditation program drives improvements in the clinical practice of giving pro re nata [PRN] antipsychotic medications for psychiatric inpatients. This study was conducted in October 2012, a record-based pre-post assessment design in psychiatric inpatient wards at King Khalid University Hospital, Riyadh, Saudi Arabia. Data collected from a 12-month pre-accreditation period [July 2009 to June 2010] was compared with those from a 12-month post-accreditation period [July 2011 to June 2012]. The collected data identified demographics, diagnosis, number of PRN antipsychotic medications administered per patient, and indications for use. There were 177 patients during the pre-accreditation period, and 182 patients during the post-accreditation period. Before accreditation, 87% of patients were administered PRN antipsychotics and the average number of PRN antipsychotic administrations per patient was 12.10 +/- 7.0 compared with 81% of patients being administered 7.47 +/- 3.2 PRN antipsychotic medications per patient post-accreditation. Prior to accreditation, a high number of PRN antipsychotic medications were administered to patients with no specified indications [rs=0.698; p<0.001]. During the post-accreditation period, the corresponding correlation coefficients significantly declined to rs=0.465; p<0.001. Implementation of clinical practice guidelines in psychiatric inpatients significantly reduces the frequency of PRN antipsychotic medications and enhances patient safety