Use of Academic Detailing With Audit and Feedback to Improve Antipsychotic Pharmacotherapy.

Objective: Second-generation antipsychotics vary in their propensity to cause serious cardiometabolic side effects. In addition, use of two or more antipsychotics (polypharmacy) may lead to additive side effects and has not been shown to be consistently more effective than monotherapy. This study examined the use of academic detailing with audit and feedback to improve antipsychotic prescribing practices, including antipsychotic polypharmacy and utilization of medication with high or low risk of cardiometabolic side effects ("high risk" or "low risk," respectively).

Expanding the Role of Psychiatric Mental Health Nurse Practitioners in a State Psychiatric System: The New Hampshire Experience.

Psychiatric mental health nurse practitioners (PMHNPs) are assuming increasing clinical responsibilities in the treatment of individuals with mental illness as the shortage of psychiatrists and their maldistribution continues to persist in the United States. States vary widely in their statutes and administrative rules delineating PMHNP's scope of practice. This column describes the legislative process of incremental changes in New Hampshire statute and rules changes over the past 15 years that have significantly expanded PMHNP's ability to treat individuals with mental illnesses in the state mental health system.

Nurse-police coalition: improves safety in acute psychiatric hospital.

Although police officers protect and secure the safety of citizens everywhere, nurses are the primary guardians of patient safety within the treatment milieu. At New Hampshire Hospital, both nurses and police officers share ownership of this responsibility, depending on the needs that arise specific to each profession. Psychiatric nurses take pride in their ability to de-escalate agitated and potentially aggressive patients; however, times arise when the best efforts of nurses fail, or when a situation requires intervention from police officers.

Seclusion and restraint use in children and adults: differences between age groups.

This 1-year study of seclusion and restraint in an acute inpatient psychiatric hospital revealed a marked difference in reasons and duration for adults, children, and adolescents. Children and adolescents are most often secluded and restrained in response to identifiable patterns of dangerous behavior, and episodes of seclusion and restraint involving children and adolescents are considerably shorter than episodes involving adults. This information is being used to find ways to improve the care and treatment of all patients, especially for children.

Best practices: The Administrative Review Committee at New Hampshire Hospital: a one-year follow-up.

New Hampshire Hospital implemented an Administrative Review Committee (ARC), a best practice that provides a risk management process to mitigate potential liability for the hospital and clinicians treating high-profile, high-risk patients. This column reports on the first year of the ARC's operation, during which the committee reviewed 206 patients. The authors describe four patient groups and their distinguishing characteristics.

Psychiatric patients are at increased risk of falling and choking.

Acutely ill psychiatric patients experience symptoms and take medications that increase their risk of both falling and choking; however, nurses and other caregivers may not be keenly aware of these risks. This article will provide a brief review of the literature related to risk factors for falls and choking and interventions to prevent falls and choking. Increased education for nursing students and staff employed at inpatient psychiatric units has the potential to reduce both incidence and injuries related to falls and choking.

Public-academic partnerships: a program to improve the quality of antipsychotic prescribing in a community mental health system.

State mental health authorities can use public-academic partnerships to create professional roles in which leaders can track trends, identify problems, and carry out quality improvement projects to address key issues. Leaders with positions in both academic institutions and state mental health authorities ensure access to resources, technical expertise, and key relationships to improve quality. The authors describe a public-academic partnership in New Hampshire and a quality improvement program it carried out.

Transforming the culture of caring.

Direct care staff struggle with the decision of when to physically intervene with patients. There is a widely held belief that they are expected to place themselves in danger of harm to prevent patients from hurting themselves or others. In this acute mental health care setting, an educational program was developed, using principles of adult and transformational learning, to dispel the idea that getting hurt is part of the job.

Best practices: Use of an administrative review committee at New Hampshire Hospital to mitigate risk with high-profile patients.

An increasing number of patients manifesting violent and aggressive behaviors are treated at New Hampshire Hospital. Over the past ten years, the volume of referrals on an involuntary emergency petition has increased 70%. New Hampshire Hospital has successfully initiated its Administrative Review Committee, which confers a risk management process to mitigate potential liability for the hospital and treating clinicians for these high-risk patients.

Executive-level reviews of seclusion and restraint promote interdisciplinary collaboration and innovation.

Elimination of seclusion and restraint requires support at all levels of an organization, especially from leaders who visibly champion and communicate their vision. Nurses, physicians, educators, and administrators at New Hampshire Hospital, an acute psychiatric inpatient facility, have established a standard meeting time and place for an executive-level review of every episode of seclusion and restraint. The standing meeting demonstrates the organization's commitment to caring for both patients and staff.

State mental health policy: Promoting legislation and public policy debates in state legislatures: a psychiatrist's perspective.

Psychiatrists are urged to get involved in promoting legislation and public policy debates in state legislatures to effectively advocate for positive change in legislation and policy making. This column focuses on strategies that New Hampshire Psychiatric Society members have found effective in engaging policy makers and legislators in a dialogue that assertively promotes the views of patients with mental illness and the profession of psychiatry.