Enhancing safety and compliance in acute behavioural disturbance management: Pilot of proposed update to zuclopenthixol acetate guidelines in a regional PICU

Abstract

Objectives

Zuclopenthixol acetate (ZA) is commonly used in psychiatric intensive care units (PICUs) to manage acute behavioural disturbance (ABD). Despite its clinical utility, monitoring practices remain inconsistent, creating issues such as oversedation and cardiac risk. This study aimed to evaluate compliance with existing Queensland ABD guidelines, benchmark standards, and develop and pilot a proposed revision to the Queensland state guideline to strengthen monitoring and improve patient safety.

Methods

In this quality improvement project, a proposed ABD management guideline was synthesised from key guidelines identified by literature review. Baseline ZA practice was assessed in a regional PICU against the proposed ABD guideline. Following staff education and guideline implementation, pre/post outcomes were evaluated.

Results

Eighty-eight patients were included. Following ABD guideline implementation, compliance improved significantly for pre-ZA blood tests (49.3% to 84.2%, p < .01) and ECGs (43.5% to 83.3%, p < .01), and at discharge (ECG 33.3% to 83.3%, p < .01). Baseline documentation improved from 30.9% to 83.3% (p < .01). Improvements were consistent across patient demographics, except for higher discharge ECG completion in non-Indigenous patients (p = .04).

Conclusions

Implementation of the proposed ABDM guideline markedly improved monitoring and documentation of ZA use. These findings provide evidence for state-wide adoption to support safer and more consistent care.