Lean methodology reduces inappropriate use of antipsychotics for agitation at a psychiatric hospital

OBJECTIVE: To evaluate the effects of applying lean methodology - improving quality, increasing efficiency by eliminating waste, and reducing costs - an approach to decrease the prescribing frequency of antipsychotics for the indication of agitation. DESIGN: Historically controlled study. SETTING: Sheppard Pratt health system is the largest private provider of psychiatric care in Maryland, with a total bed capacity of 300. There were 4,337 patient days from November 1, 2012 to October 31, 2013 on the dementia unit. PATIENTS: All patients admitted on the dementia unit were 65 years of age and older with a primary diagnosis of dementia. INTERVENTION: Our multidisciplinary team used lean methodology to identify the root causes and interventions necessary to reduce inappropriate antipsychotic use. MAIN OUTCOME MEASURES: The primary outcome was rate of inappropriately indicating agitation as the rationale when prescribing antipsychotic medications. RESULTS: There was a 90% (P < 0.001) reduction in rate of antipsychotic prescribing with an indication of agitation. CONCLUSION: The lean methodology interventions led to a 90% (P < 0.001) reduction in the rate of antipsychotic prescribing with an indication of agitation and a 10% rate reduction in overall antipsychotic prescribing.