Method:
A retrospective audit of patients admitted to the Alfred Psychiatry in-patient facility from 1 October 2004 to 31 January 2006. Patient demographics, in-patient length of stay and medication usage data were extracted from the patient's medical record. High-dependency unit (HDU) length of stay was also calculated. Information regarding Code Blues, Medical Emergency Team calls, Code Greys, staff and patient incidents, and patient seclusion were also collected.
Results:
There were a total of 1563 admissions to Alfred Psychiatry in-patient units during the total study period. Of these admissions, 614 included treatment in the HDU, and 313 of these HDU admissions were available for collection. Staff injuries decreased significantly from 18 in the preimplementation period to 6 in the postimplementation period (P = 0.02), while patient falls also decreased significantly from 17 to 1 (P = 0.0003), and patient-on-patient assaults decreased significantly from nine to zero (P = 0.007). The number and length of seclusions trended up but not significantly (P = 0.07). The use of midazolam trended down, which was clinically, but not statistically, significant. There was also a signifiant increase in the mean total dose of oral olanzapine used as a when-required medication from 7.2 to 22.2 mg (P = 0.003).
Conclusions:
The introduction of acute sedation practice guidelines in the Alfred in-patient psychiatry service improved staff safety by decreasing the number of staff injuries and improved patient outcomes by decreasing the number of patient falls and patient-on-patient assaults.
