P.r.n. medication use in a psychiatric high‐dependency unit following the introduction of a nurse‐led activity programme

Thomas, Ben D. H.; Jones, Margaret; Johns, Paul; Trauer, Tom

doi:10.1111/j.1447-0349.2006.00433.x

Cited by 16 publications

(10 citation statements)

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“…Nevertheless, they turned out to be the intervention type significantly associated with the decrease of the perceived risk of violence, and the use of purposeful activities have been reported to reduce the use of both seclusion, restraint and PRN-medication [43, 44]. It is worth noting that discussion with a psychiatrist was mentioned as an intervention only three times during the whole 6-month study period, although there were two psychiatrists working on the ward.…”

Section: Discussionmentioning

confidence: 99%

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward

Kaunomäki

Jokela

Kontio

et al. 2017

BMC Health Serv Res

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BackgroundPatient aggression and violence against staff members and other patients are common concerns in psychiatric units. Many structured clinical risk assessment tools have recently been developed. Despite their superiority to unaided clinical judgments, staff has shown ambivalent views towards them. A constant worry of staff is that the results of risk assessments would not be used. The aims of the present study were to investigate what were the interventions applied by the staff of a psychiatric admission ward after a high risk patient had been identified, how frequently these interventions were used and how effective they were.MethodsThe data were collected in a naturalistic setting during a 6-month period in a Finnish psychiatric admission ward with a total of 331 patients with a mean age of 42.9 years (SD 17.39) suffering mostly from mood, schizophrenia-related and substance use disorders. The total number of treatment days was 2399. The staff assessed the patients daily with the Dynamic Appraisal of Situational Aggression (DASA), which is a structured violence risk assessment considering the upcoming 24 h. The interventions in order to reduce the risk of violence following a high DASA total score (≥4) were collected from the patients’ medical files. Inductive content analysis was used.ResultsThere were a total of 64 patients with 217 observations of high DASA total score. In 91.2% of cases, at least one intervention aiming to reduce the violence risk was used. Pro re nata (PRN)-medication, seclusion and focused discussions with a nurse were the most frequently used interventions. Non-coercive and non-pharmacological interventions like daily activities associated significantly with the decrease of perceived risk of violence.ConclusionIn most cases, a high score in violence risk assessment led to interventions aiming to reduce the risk. Unfortunately, the most frequently used methods were psychopharmacological or coercive. It is hoped that the findings will encourage the staff to use their imagination when choosing violence risk reducing intervention techniques.

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Section: Discussionmentioning

confidence: 99%

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward

Kaunomäki

Jokela

Kontio

et al. 2017

BMC Health Serv Res

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“…This had been under development towards the end of 2008, including a regular morning patient meeting. The benefits of such programmes and the influence on rates of PRN administration have been illustrated (Thomas et al . 2006).…”

Section: Explaining the Resultsmentioning

confidence: 99%

“…The extent to which these initiatives influenced the results of this study needs exploring. Furthermore, a therapeutic group programme was not yet established, and the authors regarded this as another possible influence on PRN administration, as some literature has suggested (Thomas et al . 2006).…”

Section: Introductionmentioning

confidence: 99%

Pro re nata use in a psychiatric intensive care unit

Mullen

Drinkwater

2011

International Journal of Mental Health Nursing

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Pro re nata (PRN) or 'as required' medication is a regular part of mental health nursing practice. This retrospective study accessed data recorded for all PRN being given to patients within an eight-bed psychiatric intensive care unit. Data from the same consecutive 4-month period from 2005 and from 2007-2009 were analysed for trends in overall rates, time of administration, and type of medication given. PRN administration was identified to each patient, but no demographic information was analysed. Results of this study demonstrated a gradual decline in the total number of PRN given, reducing from an average of 314 PRN per month in 2005, to 181 PRN per month in 2009. The typical number of patients per month receiving any PRN did not change, with 41 out of a total of 72 patients receiving at least one PRN in 2005, and 40 out of 64 patients receiving PRN in 2009. These results suggest that over the study timeframe, nurses became more selective as to which patients received PRN. This discussion examined the possible reasons for this result, including unit leadership style, changes in staffing levels, a new nursing model and group programme, and the relocation to a new facility.

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“…There was limited indirect evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Thomas et al (2006) Crossover intervention study of 228 clients who required psychiatric intensive care Activity program consisting of movement to music and games/activities An intervention was effective in reducing the number of p.r.n. medications dispensed in a high-dependency unit compared with control conditions.…”

Section: Massage Interventionmentioning

confidence: 99%

The Contribution of Nursing to High-Value Inpatient Care

Kurtzman

2010

Policy, Politics, & Nursing Practice

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Reports of suboptimal health care quality and rising expenditures have led payers to institute policies intended to improve outcomes and lower costs. Referred to as value--driven health care, these policies have multiplied in recent years. Despite their appeal, nursing--the nation's single largest provider of health care-has largely been excluded from these policy directions. This article describes the nature of the evidence substantiating nursing's contribution to quality and cost and explores the reasons--scientific, economic, societal, and political--that these contributions have been largely ignored in the formulation of federal policy. Recommendations are made to strengthen the nurse-value case and convince health care stakeholders, including policy makers, that the relationship is established, enduring, and sufficient for national action.

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P.r.n. medication use in a psychiatric high‐dependency unit following the introduction of a nurse‐led activity programme

Cited by 16 publications

References 11 publications

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward

Pro re nata use in a psychiatric intensive care unit

The Contribution of Nursing to High-Value Inpatient Care

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