Ativan Use in the Senior Adult: A Collaborative Effort with the Emergency Department

Donna J. Silva, RN-BC

Situation/Background Geriatric Resource Nurses familiar with the Beers List, on a 32 bed mixed acuity senior adult unit perceived an increase in the number of patients admitted with behavioral disturbances receiving Ativan IV in the ED in August 2014.

Assessment A review of 80 patients admitted from the ED over a 60 day period with a diagnosis of • UTI • altered mental status • confusion • aggressiveness • agitation • encephalopathy determined a 12% usage of IV Ativan in this population.

Recommendations A collaborative effort between the ED pharmacist, CNS of both units and ED Medical Director, yielded education for the Medical Providers. A review of 123 charts over the next 4 months revealed that usage had decreased to 8%.

Physician Education The ED pharmacist developed a tool for dosing of medications available for usage with patients presenting with behavioral disturbances. This tool included assessing for causes of behaviors, pain medication recommendations to include acetaminophen as a first line medication, and dosages for safer antipsychotic medications according to the Beers list. This education was approved by our Geriatrician/Senior Care Services Medical Director.

RN Education A poster presentation was provided which included the copyrighted MHSM Dementia with Behavioral Disturbances algorithm, Ten Absolutes of Dementia Care, Ten Rules for Dementia Care and the link to the “Try This Series” from the NICHE Knowledge Center. See available handouts.

Results Ongoing review of 226 charts has revealed that Ativan was used in only 0.5% of the cases.

August 2014 IV Ativan Usage Trend

12% Sep-Dec 2014

8% Ongoing/Recent Review

0.5%