Audit of medication management of acute behavioural disturbance: exploring the impact of a clinical practice guideline

Abstract

Objective This paper describes an evaluation of the impact of a concise, portable guideline for the medication management of acute behavioural disturbance in adult psychiatric inpatient units.Setting Waitemata District Health Board provides inpatient psychiatric care for an adult catchment population of about 800 000 at two units located in west and north Auckland, New Zealand with a total of 68 beds.Method A retrospective clinical audit of the first 72 hours' medication management for patients admitted in acute crisis was completed before and after formal guideline implementation.Key findings Benzodiazepines were the medication of choice. Total daily doses for both benzodiazepines and antipsychotics were within recommended ranges. Areas of practice that appeared to improve after guideline implementation included reduced use of antipsychotic and short-acting injectable medications and use of lorazepam as sole treatment, but differences were not statistically significant.Conclusion Pharmacological management was found to be consistent with best clinical practice before and after guideline implementation.