Adherence with an Acute Agitation Algorithm and Subsequent Restraint Use
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Adherence with an Acute Agitation Algorithm and Subsequent Restraint Use Meredith Jenkins 1 & Michelle Caruso Barrett 1 & Theresa Frey 2,3 & Kamali Bouvay 2,3 & Drew Barzman 3,4 & Eileen Murtagh Kurowski 2,3 Accepted: 15 November 2020/ # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Timely use of pharmacological interventions to treat acute agitation has the potential to decrease physical restraint use. The aim of this study is to determine if adherence to standardized pharmacological recommendations for the treatment of acutely agitated pediatric patients decreases physical restraint use. Additionally, this study aims to identify predictors of physical restraint use and describe treatment related adverse events. This is a retrospective chart review of patient visits between September 1, 2016 and August 31, 2017. Patient visits were included if the patient presented to the pediatric emergency department, met ICD-10 codes, and received pharmacologic management or physical restraint to treat acute agitation. The differences in rate of physical restraint was assessed between patients treated according to the standardized pharmacological recommendations and patients who were not. 447 patients were included with a mean age of 13 years. No significant difference in physical restraint use was found when standardized pharmacological recommendations were followed compared to when they were not (P = 0.16). Only presentation on day shift when compared to evening shift resulted in increased odds of being restrained (OR 2.03; 95% CI 1.18, 3.50). Nine adverse events possibly related to medications were identified with none considered to be of significant clinical concern. Standardized pharmacological treatment recommendations was not associated with a decrease in physical restraint use for agitated patients presenting to the pediatric emergency department. The pharmacologic strategies utilized were generally safe and well tolerated in this patient population. Keywords Pediatric emergency medicine . Acute agitation . Restraints . Antipsychotics
Introduction Visits to pediatric emergency departments (PEDs) for mental health crises are a growing concern [1]. Violent behavior, depression, and suicide are the most common psychiatric chief * Meredith Jenkins [email protected] Extended author information available on the last page of the article
Psychiatric Quarterly
complaints for pediatric patients presenting to the PED [2]. Acute agitation has previously been defined as “a state of behavioral dyscontrol that will likely result in harm to the patient or healthcare workers without intervention.” [3] Injury to patients and staff during the treatment of acute agitation in the ED (emergency department) is a significant problem [4, 5]. If agitation becomes a threat to the patient, family, or staff, acute interventions are necessary with the goal of preventing harm to the patient and others involved in his/her care [6, 7]. The optimal management strategy for pediatric patients presenting with ac
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