PRN Oral/IM Lorazepam for Rapid Control of Acutely Disturbed Behaviour in Older Adults (Over 65)

Background: Lorazepam is common ly used for the treatment of acute behavioural disturbance and violence/aggression in the older population. It is associated with sedation, increased risk of falls and paradoxical disinhibition. 1,4,5 The current NICE guideline recommends patient monitoring after intramuscular (IM) administration of lorazepam for RT but not for oral lorazepam, even though both routes of administration achieve peak plasma concentration within two hours (range between 1 and 6h). 2 In May 2018, PRN oral Lorazepam use in older adult inpatients for acutely disturbed behaviour was audited. The results were then disseminated among the old-age psychiatry colleagues with learning points. Since then, the electronic documentation of patient observations has been implemented between 2018 and 2019 to improve compliance with monitoring and recording vital signs. This re-audit was undertaken in November 2019 using the same standards, however, both oral and intramuscular administration of lorazepam have been included for older adult inpatients treated for acutely disturbed behaviour. Subjects and Methods: Data were collected retrospectively for older adult inpatients who were treated with oral and/or intramuscular lorazepam PRN during admission. A data collection tool was created and charted against the standards. Results: Overall, it can be concluded that the reaudit showed improvement in use of de-escalation techniques, documenting treatment episode for RT, and hydration of patients. There was no improvement in monitoring patients’ response and vital signs for oral and IM lorazepam treatment episodes. Conclusions: We recommend some action points to ensure compliance with adequate monitoring following its use in RT. For example, the training for nursing colleagues and promoting safe prescription of PRN lorazepam.