Title: The PRN Project: A Clinical Review and Quality Improvement Project

Biography:

Brock Dale is a clinical pharmacist with a specialty in Mental Health working within Lakes District Health Board, Rotorua Hospital New Zealand. His current role includes acute inpatient work as well as a case load of patients with in the mental health service for older person’s team. He is a current finalist for New Zealand Pharmacist of the Year 2018. He is also currently pursuing his Post Graduate Diploma in Clinical Pharmacy.

Abstract

The mainstay of management of patients presenting agitated and aggressive in the context acute mental disorder is with symptom triggered ‘as required’ (PRN) benzodiazepines and/or antipsychotics. The present clinical review and quality improvement project identified a culture based on a reliance on heavily sedating benzodiazepines for the management of such patients by way of audit, survey and clinical review. Through an intensive educational workshop series for nursing and medical staff, and the implementation of a ‘PRN Administered’ sticker, I was able to change a culture of utilising sedation for agitation and aggression to symptom triggered medication selection. Together with appropriate medication selection and adequate documentation of response to the selected medicine we were able to improve patient care and management, notably by way of drastic reduction in physical restraint and seclusion events.