Theses and Dissertations at Montana State University (MSU)
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Item Improving quality through the development of a benzodiazapine sparing protocol for treating alcohol withdrawal in a community correctional setting(Montana State University - Bozeman, College of Nursing, 2018) Hill, Wade G.; Chairperson, Graduate Committee: Maria WinesAlcohol detoxification within community correctional environments poses significant challenges to local jurisdictions that are called to manage rising rates of incarceration among citizens with complex health needs including multiple comorbidities and mental illness and substance abuse. Traditional methods for intervening during detoxification have relied upon benzodiazepine tapers to reduce chances of the most serious consequences of alcohol withdrawal syndrome (AWS) but these medications have been increasingly attributed to poor outcomes such as increased risks of delirium, medication interactions, and risk of diversion among others. This project describes an evidence-based benzodiazepine sparing protocol that can be used to avoid use of this class of medications as well as an associated education intervention for detention officers and healthcare staff in one community correctional institution designed to improve knowledge of monitoring and treatment for inmates suffering from AWS. In total, 28 staff participated in the training and results suggest excellent overall quality and accomplishment of objectives at a high level. Implications for advanced practice nursing are discussed as well as directions for future dissemination efforts for BZ-sparing treatment.Item Benzodiazepine prescription evaluation on inpatient psychiatry(Montana State University - Bozeman, College of Nursing, 2018) Loven, Jill Marie; Chairperson, Graduate Committee: Maria WinesSince the Food and Drug Administration announced on August 31, 2016 it was requiring boxed warnings regarding the risk of respiratory depression and death when benzodiazepines are combined with opioid, facilities face growing scrutiny of benzodiazepine utilization. Benzodiazepines are an effective treatment for acute anxiety and often administered to patients who require inpatient psychiatric treatment. Medication Utilization Evaluation (MUE) is a multidisciplinary quality improvement method that can evaluate safety and utilization of medications in a facility. This MUE pilot project identified 261 records of patients prescribed benzodiazepines in a facility from January 1, 2017-March 31, 2017. Results showed that 75% of the sample received appropriate orders for benzodiazepine. Potential factors to predict inappropriate orders were depression and alcohol withdrawal. More information is needed pertaining to the actual utilization of benzodiazepines on the inpatient unit.