PDF(Pubmed)
Abstract：
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目的：目前尚不清楚临床试验的证据如何最好地转化为复杂的临床环境。此质量改进（QI）项目的目的是改变处方实践，以在住院精神卫生保健服务中快速镇静，检查Plan-Do-Study-Act（PDSA）方法的有效性。
方法：进行了前瞻性QI项目，以确保在住院精神保健中，肌内（IM）地西泮被IM劳拉西泮代替苯二氮卓类药物的快速镇定。我们监测了药物的处方和给药之前的快速镇静（N=371），在QI干预期间(N=1130)和之后(N=364)。使用多组分干预方法进行了七个迭代PDSA循环，以逐渐将处方实践转向所需的方向。同时,为了确保患者安全,我们引入了标准监测方案.
结果：在干预后持续的干预期间，劳拉西泮的给药逐渐取代地西泮，其中劳拉西泮占苯二氮卓给药的96％，用于快速镇静。从干预前（14.40mg地西泮当量）到干预后（14.61mg），苯二氮卓的平均剂量保持稳定。在观察期结束时达到接近完全遵守生命体征监测(>80%)。
结论：使用基于迭代PDSA循环和连续数据反馈的逐步方法，可以提高大型住院精神卫生保健机构中急性躁动的治疗质量。在当地利益相关者和意见领袖的反馈下，这种方法在其他处方实践方案中可能很有价值。
方法：进行了前瞻性QI项目，以确保在住院精神保健中，肌内（IM）地西泮被IM劳拉西泮代替苯二氮卓类药物的快速镇定。我们监测了药物的处方和给药之前的快速镇静（N=371），在QI干预期间(N=1130)和之后(N=364)。使用多组分干预方法进行了七个迭代PDSA循环，以逐渐将处方实践转向所需的方向。同时,为了确保患者安全,我们引入了标准监测方案.
结果：在干预后持续的干预期间，劳拉西泮的给药逐渐取代地西泮，其中劳拉西泮占苯二氮卓给药的96％，用于快速镇静。从干预前（14.40mg地西泮当量）到干预后（14.61mg），苯二氮卓的平均剂量保持稳定。在观察期结束时达到接近完全遵守生命体征监测(>80%)。
结论：使用基于迭代PDSA循环和连续数据反馈的逐步方法，可以提高大型住院精神卫生保健机构中急性躁动的治疗质量。在当地利益相关者和意见领袖的反馈下，这种方法在其他处方实践方案中可能很有价值。
