Agitation Assessment and Management in the Emergency Department

Abstract

Background: Agitation is common in the emergency department. When agitation is not detected early, patients can become aggressive and violent. This can lead to increased restraint use. When restraints are used, patients and staff are more likely to become injured. Local Problem: An urban emergency department reported a lack of an objective tool for assessing patient agitation. The staff of the ED desired resources to better care for behavioral health patients. Intervention: The aim of the study was to implement the Behavioral Activity Rating Scale (BARS) in the electronic medical record of an urban ED during a 14-week quality improvement project. The goals of the project were early detection and management of patient agitation, reduction of restraint use in the emergency department, and to determine the usability of the BARS using the System Usability Scale (SUS). Results: The results of retrospective chart reviews revealed that BARS was documented frequently (n=4,867 documentations) by ED RN’s to assess patient’s with behavioral health and medical complaints (n=780). Though restraint use decreased in the first two months of the project, overall restraint use was increased in 2018 (µ=5.25; SD=3.10) compared to the previous year (µ=4.75; SD=2.99; p=0.71). However, patients who were placed in restraints, remained in restraints for fewer days in 2018 (µ=1.14; SD=0.69) compared to the previous year (µ=1.68; SD=01.20; p=0.04). The results of the SUS indicated that ED nurses found BARS to be usable. Conclusion: The BARS is a quick and easy tool to assess for patient agitation. With the incorporation of agitation management interventions, the ED team can potentially manage agitation before violence occurs. Further studies are needed on the use of BARS towards managing patient agitation and reducing staff violence in the ED.