Reducing Time in Restraints for the Violently Agitated Patient in the Emergency Department

2.50
Hdl Handle:
http://hdl.handle.net/10755/198338
Title:
Reducing Time in Restraints for the Violently Agitated Patient in the Emergency Department
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Reducing Time in Restraints for the Violently Agitated Patient in the Emergency Department

Purpose: The nation’s Emergency Departments have seen a rise in the number of psychiatric visits. Roughly 75% of acute psychotic episodes in the Emergency Department are a result of patient non-compliance¹. Prolonged wait times for psychiatric patient placement compound agitation and violence associated with psychotic episodes. Violent agitation may result in the use of restraints.

The main objective of the project was to safely reduce the amount of time the violently agitated psychiatric patient remained in restraints. The effort focused on calming the violently agitated psychiatric patient through the use of psychotropic medication, thus reducing the patient’s risk of imminent and serious harm to the patient and/or others.

Design: The Emergency Department’s Leadership Team and Clinical Pharmacists developed a patient safety project to safely reduce the amount of time the violently agitated psychiatric patient was in restraints. The Positive and Negative Syndrome Scale (PANSS)² was used to assess the patient’s level of agitation and appropriate dose of psychotropic medication.

Setting: The project took place in an urban Level II trauma center Emergency Department. The Emergency Department sees approximately 400 psychiatric patients each month. The hospital has a Mental Health Center with services for both inpatients and outpatients

Participants/Subjects: The project included both male and female adult psychiatric patients presenting to the Emergency Department by self referral or EMS. Patients who were under the influence of substances were excluded from the project as these patients were considered medical patients.

Methods: The project team researched several Behavioral Scales and medication choices. The project team chose the Positive and Negative Syndrome Scale (PANSS)² which reflects seven different assessment criteria; Delusions, Conceptual Disorganization, Hallucinatory Behavior, Excitement/Agitation, Grandiosity, Hostility, and Suspiciousness/Persecution. The patient was given psychotropic medication according to the level of agitation. The patient was reassessed in one hour. Based on the reassessment a plan for removal of restraints was initiated or the patient was re-medicated. Education of the ED staff began first week of June and the protocol was implemented July 1, 2009

Results/Outcomes: There were 161 patients reviewed since the implementation of the Behavioral Scale. The trial successfully reduced the time in restraints by 37%. Mean time pre implementation was 176 minutes and post implementation was 108 minutes. Three patients did not respond to psychotropic medications and remained in restraints for seven and a half hour average length of time.

Implications: Using the PANSS to assess agitation and medicate appropriately results in a reduction in the amount of time a patient is restrained. Hourly assessment following administration of psychotropic medication expedites the determination of patient readiness for restraint removal and appropriate medical and psychiatric evaluation prior to discharge, admission, or transfer.
Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleReducing Time in Restraints for the Violently Agitated Patient in the Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/198338-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Reducing Time in Restraints for the Violently Agitated Patient in the Emergency Department<br/><br/>Purpose: The nation’s Emergency Departments have seen a rise in the number of psychiatric visits. Roughly 75% of acute psychotic episodes in the Emergency Department are a result of patient non-compliance¹. Prolonged wait times for psychiatric patient placement compound agitation and violence associated with psychotic episodes. Violent agitation may result in the use of restraints.<br/><br/>The main objective of the project was to safely reduce the amount of time the violently agitated psychiatric patient remained in restraints. The effort focused on calming the violently agitated psychiatric patient through the use of psychotropic medication, thus reducing the patient’s risk of imminent and serious harm to the patient and/or others. <br/><br/>Design: The Emergency Department’s Leadership Team and Clinical Pharmacists developed a patient safety project to safely reduce the amount of time the violently agitated psychiatric patient was in restraints. The Positive and Negative Syndrome Scale (PANSS)² was used to assess the patient’s level of agitation and appropriate dose of psychotropic medication. <br/><br/>Setting: The project took place in an urban Level II trauma center Emergency Department. The Emergency Department sees approximately 400 psychiatric patients each month. The hospital has a Mental Health Center with services for both inpatients and outpatients<br/><br/>Participants/Subjects: The project included both male and female adult psychiatric patients presenting to the Emergency Department by self referral or EMS. Patients who were under the influence of substances were excluded from the project as these patients were considered medical patients.<br/><br/>Methods: The project team researched several Behavioral Scales and medication choices. The project team chose the Positive and Negative Syndrome Scale (PANSS)² which reflects seven different assessment criteria; Delusions, Conceptual Disorganization, Hallucinatory Behavior, Excitement/Agitation, Grandiosity, Hostility, and Suspiciousness/Persecution. The patient was given psychotropic medication according to the level of agitation. The patient was reassessed in one hour. Based on the reassessment a plan for removal of restraints was initiated or the patient was re-medicated. Education of the ED staff began first week of June and the protocol was implemented July 1, 2009<br/><br/>Results/Outcomes: There were 161 patients reviewed since the implementation of the Behavioral Scale. The trial successfully reduced the time in restraints by 37%. Mean time pre implementation was 176 minutes and post implementation was 108 minutes. Three patients did not respond to psychotropic medications and remained in restraints for seven and a half hour average length of time. <br/><br/>Implications: Using the PANSS to assess agitation and medicate appropriately results in a reduction in the amount of time a patient is restrained. Hourly assessment following administration of psychotropic medication expedites the determination of patient readiness for restraint removal and appropriate medical and psychiatric evaluation prior to discharge, admission, or transfer.<br/>en_GB
dc.date.available2011-12-21T12:46:17Z-
dc.date.issued2011-12-21T12:46:17Z-
dc.date.accessioned2011-12-21T12:46:17Z-
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