4.1 STANDARDIZED ACUTE AGITATION MANAGEMENT ACROSS HOSPITAL SETTINGS

Abstract

Increasingly more children are presenting with worsening acuity of emotional dysregulation, aggression, and agitation in the emergency department (ED) and across other hospital systems. Timely implementation of consistent behavioral health strategies and standardized pharmacological interventions are essential in successfully responding to acute and severe agitation across the continuum of care. We describe the development of an acute agitation algorithm to standardize management of agitation and aggression in the ED and the general pediatric floor. Multidisciplinary workgroups in 2 separate hospital settings at Lurie Children’s Hospital were created to develop an acute agitation algorithm with the aim of standardizing the early identification of signs and symptoms of agitation, implementing a consistent nonpharmacological and pharmacological treatment response, and utilizing consistent debriefing strategies. We developed resources to screen high-risk special populations, build electronic health record identifiers to recognize at-risk patients, create documentation that drives clinical intervention, and develop systemwide workflows and staff education to ensure consistency of implementation through the continuum of care. Stratification of the severity of agitation was used in the algorithm to match behavioral and pharmacological interventions. We will present outcome measures related to pre- and postimplementation of the ED and pediatric acute agitation algorithm, patient acuity, consistency and timeliness of protocol implementation, psychopharmacological interventions, and documentation. Aggression is a serious problem in child and adolescent psychiatry. Pandemic-related factors have contributed to a significant rise in acuity and severity of behavioral dysregulation across hospital settings. Uniform staff training around mental health, implementation of consistent behavioral health de-escalation strategies, and standardized pharmacological approaches to challenging behaviors improve patient care and staff satisfaction.