To ensure efficient care in inpatient psychiatric services, standardized practice guidelines for PRN medications are essential. Unnecessary reliance on PRN psychotropic medications for psychiatric inpatients can undermine the quality of care. On admission, about 75% of mental health patients were routinely prescribed PRN medications. The rate of administered PRN medications to patients in psychiatric units in the United States of America is 35%, Canada 50%, Britain 50% and Australia 80%. In psychiatric inpatient services, administration of pro re nata (PRN, or ‘as required’) psychotropic medication is a common practice. The ACI is a non-governmental quality organization that offers health care improvement services worldwide. The first was in February 2011, and the second was in May 2014. King Khalid University Hospital (KKUH) in Riyadh, the site of the study, obtained two cycles of accreditation from Accreditation Canada International (ACI). Several governmental hospitals in Saudi Arabia have received accreditation from different international accreditation bodies. Saudi Arabia was one of the first countries in the eastern Mediterranean region to implement health care accreditation standards. Interest in accreditation of health care organization (HCOs) is growing rapidly among developing countries. There are many adverse effects of BDZs on psychiatric inpatients including cognitive impairment, delirium, psychomotor slowing, risk of respiratory distress, oversedation, falls and hip fractures. The present study focused on BDZ medications because their clinical relevance to psychiatric inpatients. Clinicians’ over prescriptions of BZDs may result in abuse problems. Despite guideline precautions, long‐term prescription of BZDs is still a common treatment pattern. Dependence can develop to therapeutic doses of benzodiazepines, after 4–6 weeks of regular usage, but it may develop more rapidly to very high doses administered for a shorter period of time or in the case of individuals who have been previously dependent on other sedatives or alcohol. However, benzodiazepine use is also associated with potential complications of tolerance, dependence and withdrawal symptoms, risk of abuse and cognitive impairment. Benzodiazepines such as lorazepam are recommended as the drugs of first choice when rapid tranquillization is required because of their sedative effects. More recently there has been a shift away from using the sedative side-effects of antipsychotics to using benzodiazepines that sedate with minimal side-effect risks. Because of rapid tranquilizing effect, BDZs are commonly used for the control of agitation, disruptive behavior, and insomnia in psychiatric inpatients. ConclusionĪccreditation may have a positive impact on the process of administering PRN benzodiazepine medications in psychiatric inpatients.īenzodiazepines (BDZs) were developed in 1962 as a treatment for anxiety symptoms. The highest average quantity of PRN benzodiazepines administered was during the time interval of 18–24 h. There was no significant difference between the two genders. Post-accreditation, the average number of PRN benzodiazepines administrations per patient, was 4.83 ± 2.1 compared to 6.19 ± 3.4 pre-accreditation. There was a statistically significant (P < 0.002) reduction of approximately 22% in the number of administered PRN benzodiazepines. All identified charts were reviewed there were no exclusion criteria. Compiled information included demographics, diagnosis, assessment, and LOS. The adoption of accreditation standards occurred over a 12-month period in the middle of the study (July 2010–June 2011). Data obtained from the 12-month-post-accreditation period (July 2011–June 2012) were compared with those from the 12-month-pre-accreditation period (July 2009–June 2010). The study reviewed medical records of consecutive hospital admissions for pre- and post-accreditation comparisons of PRN benzodiazepine medications in two acute mental health wards at a teaching general hospital. We aimed to investigate whether hospital accreditation drives improvements for administered pro re nata benzodiazepines in psychiatric inpatients. An interest in accreditation is growing rapidly among many countries to enhance the quality of health care services. Benzodiazepine use is associated with potential complications of risk of abuse, cognitive impairment, and falls. In psychiatric inpatients, administration of pro re nata benzodiazepines is a common practice.
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