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5 results

  • The “CHROME criteria”: Tool to optimize and audit prescription quality of psychotropic medications in institutionalized people with dementia

  • Ruben Muñiz, Alia I. Pérez-Wehbe, Francisco Couto, María Pérez, Noemí Ramírez, Alejandro López, Javier Rodríguez, Teresa Usieto, Lietzan Lavin, Ana Rigueira, Luis Agüera-Ortiz, Jorge López-Alvarez, Manuel Martín-Carrasco, Javier Olazarán
  • Journal:
    International Psychogeriatrics / Volume 32 / Issue 3 / March 2020
    Published online by Cambridge University Press:
    22 October 2019, pp. 315-324
    • Article
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  • Objective:

    Describe and validate the CHROME (CHemical Restraints avOidance MEthodology) criteria.

    Design:

    Observational prospective longitudinal study.

    Setting:

    Single nursing home in Las Palmas de Gran Canaria, Spain.

    Participants:

    288 residents; mean age: 81.6 (SD 10.6). 77.4% had dementia.

    Intervention:

    Multicomponent training and consultancy program to eliminate physical and chemical restraints and promote overall quality care. Clinicians were trained in stringent diagnostic criteria of neuropsychiatric syndromes and adequate psychotropic prescription.

    Measurements:

    Psychotropic prescription (primary study target), neuropsychiatric syndromes, physical restraints, falls, and emergency room visits were semi-annually collected from December 2015 to December 2017. Results are presented for all residents and for those who had dementia and participated in the five study waves (completer analysis, n=107).

    Results:

    For the study completers, atypical neuroleptic prescription dropped from 42.7% to 18.7%, long half-life benzodiazepines dropped from 25.2% to 6.5%, and hypnotic medications from 47.7% to 12.1% (p<0.0005). Any kind of fall evolved from 67.3 to 32.7 (number of falls by 100 residents per year). Physicians’ diagnostic confidence increased, while the frequency of diagnoses of neuropsychiatric syndromes decreased (p<0.0005).

    Conclusions:

    Implementing the CHROME criteria reduced the prescription of the most dangerous medications in institutionalized people with dementia. Two independent audits found no physical or chemical restraint and confirmed prescription quality of psychotropic drugs. Adequate diagnosis and independent audits appear to be the keys to help and motivate professionals to optimize and reduce the use of psychotropic medication. The CHROME criteria unify, in a single compendium, neuropsychiatric diagnostic criteria, prescription guidelines, independent audit methodology, and minimum legal standards. These criteria can be easily adapted to other countries.

  • Chapter 31 - Disaster and terrorism emergency psychiatry

  • from Section 5. - Special populations
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 230-234

  • Summary

    Restraints are used in the healthcare setting primarily in two general situations: violent and/or self-destructive situations when the patient has demonstrated or poses an imminent danger to themselves or another, and disruption of therapy or non-violent, non-self-destructive situations. Chemical restraints are an effective and safe tool in caring for patients when used wisely. This chapter intends to provide an overview of the pharmacology, indications, side effects, and dosages of the three most commonly used medications for chemical sedation: lorazepam, haloperidol, and ketamine. Physical restraint application requires training and the demonstrated competency of involved staff. Alternatives to both chemical and physical restraints should always be explored before their initiation. Seclusion is another form of behavior control used in emergency departments and hospitals, and is simply defined as the confinement of a patient in a closed space for a specific amount of time.

  • Chapter 32 - Trauma and loss in the emergency setting

  • from Section 5. - Special populations
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 235-243

  • Summary

    This chapter reviews the most common psychiatric medications used in the emergency setting. It discusses the larger group of psychiatric medications one encounters daily on patients' medication lists. The most commonly prescribed psychiatric medications are the antidepressants, subdivided into four classes: tricyclic antidepressants (TCAs), heterocyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs). Antipsychotics, despite numerous side effects, have revolutionized the treatment of schizophrenia, allowing patients who once had to be hospitalized to live fairly normal lives. Several medications are considered mood stabilizers, also referred to as antimania medications. They include lithium, carbamazapine, valproic acid, and some atypical antipsychotics. Chemical restraint of an agitated patient is perhaps the most common reason psychiatric medications are used in the emergency department. The most common medications used for chemical restraint are haloperidol, droperidol, ziprasidone, olanzipine, lorazepam, and midazolam. The atypical antipsychotics are increasingly being used for acute agitation.

  • Chapter 35 - Management of psychiatric illness inpregnancy in the emergency department

  • from Section 5. - Special populations
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 260-269

  • Summary

    Psychiatric patients in the emergency department (ED) present unique and difficult challenges for the emergency medicine physician. This chapter reviews current therapies, as well as newer and investigational treatment options useful to diminish acute psychiatric symptoms. All ED staff involved in the use of restraints must be well versed in criteria for use of restraints and their proper and appropriate application. The most used typical antipsychotics in the ED for rapid lysis of acute psychosis have been haloperidol (Haldol) and droperidol (Inapsine). The atypical antipsychotics such as risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon) have a pharmacologic profile that is favorable. An agent that would provide the acute lysis of suicide thoughts and provide for a cooling off period for patients while they achieve therapeutic benefit from antidepressant therapy and receive outpatient therapy would be quite useful in the ED setting.

  • Chemical restraint of endangered mammals for conservation purposes: a practical primer

  • Steven A. Osofsky, Karen J. Hirsch
  • Journal:
    Oryx / Volume 34 / Issue 1 / January 2000
    Published online by Cambridge University Press:
    24 April 2009, pp. 27-33
    Print publication:
    January 2000
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  • Wild mammals sometimes need to be restrained for conservation purposes. Game rangers, wildlife managers, field biologists and wildlife veterinarians need to be fully conversant with a wide array of environmental and biological variables when using chemical restraint on wild mammals. In order to minimize risks to subject animals, they also need to be able to react appropriately using the correct equipment with sufficient skill to deal with anything that can go wrong. The importance of thorough background research and planning before going into the field cannot be overemphasized. The physiological results of immobilization drugs delivered by dart depend on dosages, the success of dart placement and drug delivery in good muscle, as well as the physiological state of the animals prior to and during anaesthetic induction. This paper describes the essential components of a planning and monitoring protocol for chemically restraining terrestrial mammals under field conditions.