Decreasing Anxiety Levels and use of Antianxiety Medication in the Behavioral Health Inpatient Setting

Abstract

Problem: Reducing the anxiety of patients on an adult inpatient psychiatric unit can be challenging. Prescribed benzodiazepines are the primary medication of choice in reducing anxiety. In 2013, approximately 31% of fatal overdoses involved benzodiazepines in United States. Approximately 70% of the patients admitted to a 16-bed inpatient psychiatry unit in the mid-Atlantic are prescribed anti-anxiety medications to include benzodiazepines. Patients with high levels of anxiety tend to request pro re nata (PRN) anti-anxiety medications 2-3x more than patients that do not request for PRN anti-anxiety medication. Purpose: This quality improvement (QI) project aimed to implement mindfulness education techniques and resources to reduce the use of PRN anti-anxiety medications. Methods: This project was implemented over 14 weeks from October-January 2022. A mindfulness education module for staff was developed to ensure that all necessary documentation (e.g., Dynamic Appraisal of Situational Aggression (DASA), mood rating, group therapy attendance, and Mindfulness iPad usage) were conducted and documented in the electronic health record (EHR). Social work introduced and reinforced mindfulness techniques in group therapy. Patients’ attendance is documented in their EHR every shift. Nurses assessed DASA scores, mood ratings and usage of Mindfulness iPad in the EHR. Once a week team project lead audits EHR charting and collects data on the usage of anti-anxiety medication in addition to the documentation. Results: The data reflects 20% utilization of the Mindfulness iPad by nursing staff, and no appreciable reduction in PRN anti-anxiety medication. Analysis of the data’s mindfulness group attendance component reflects a sustained rate of group attendance at 85%. Conclusions: Project implementation was met with many challenges including the acuity of the unit and the introduction of new technology. A continuous education plan and a user-friendly mindfulness application is recommended.