Lean methodology reduces inappropriate use of antipsychotics for agitation at a psychiatric hospital

Joshana K. Goga, Antonio Depaolo, Sunil Khushalani, J. Ken Walters, Robert Roca, Marc Zisselman, Christopher Borleis

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To evaluate the effects of applying lean methodology - improving quality, increasing efficiency by eliminating waste, and reducing costs - an approach to decrease the prescribing frequency of antipsychotics for the indication of agitation. DESIGN: Historically controlled study. SETTING: Sheppard Pratt health system is the largest private provider of psychiatric care in Maryland, with a total bed capacity of 300. There were 4,337 patient days from November 1, 2012 to October 31, 2013 on the dementia unit. PATIENTS: All patients admitted on the dementia unit were 65 years of age and older with a primary diagnosis of dementia. INTERVENTION: Our multidisciplinary team used lean methodology to identify the root causes and interventions necessary to reduce inappropriate antipsychotic use. MAIN OUTCOME MEASURES: The primary outcome was rate of inappropriately indicating agitation as the rationale when prescribing antipsychotic medications. RESULTS: There was a 90% (P < 0.001) reduction in rate of antipsychotic prescribing with an indication of agitation. CONCLUSION: The lean methodology interventions led to a 90% (P < 0.001) reduction in the rate of antipsychotic prescribing with an indication of agitation and a 10% rate reduction in overall antipsychotic prescribing.

Original languageEnglish (US)
Pages (from-to)54-62
Number of pages9
JournalConsultant Pharmacist
Volume32
Issue number1
DOIs
Publication statusPublished - Jan 1 2017
Externally publishedYes

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Keywords

  • Agitation
  • Alzheimer's
  • Antipsychotics
  • Behavioral and psychological symptoms of dementia
  • Centers for medicare & medicaid services
  • Dementia
  • Root-cause analysis

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Goga, J. K., Depaolo, A., Khushalani, S., Walters, J. K., Roca, R., Zisselman, M., & Borleis, C. (2017). Lean methodology reduces inappropriate use of antipsychotics for agitation at a psychiatric hospital. Consultant Pharmacist, 32(1), 54-62. https://doi.org/10.4140/TCP.n.2017.54