PHARMACOLOGICAL PRESCRIPTION PATTERN FOR AGITATED ADULT PATIENTS IN AN AUSTRALIAN TERTIARY HOSPITAL

Abstract

Background: Agitation in patients with a variety of aetiologies are commonly seen in hospitals. 1,2 There are a number of pharmacological modalities to treat agitation, including different classes and routes of medication. This may result in junior, inexperienced doctors to provide inappropriate medication for the management of an agitated patient. Currently, there is a guideline but no protocol for medical practitioners in Gold Coast University Hospital (GCUH) in the treatment of adult agitated patients. 3 Aim: The aim of this retrospective cohort study is to evaluate the pattern of pharmacological treatment for adult agitated patients in GCUH. Method: A retrospective cohort study was conducted using data from agitated patients between January 2016 and June 2017. 100 patients over the age of 18 were included in this study. Patients from the neurological and psychiatric wards were excluded because they have a long‐term treatment plan for their underlying conditions. Data were collected from the Electronic Medical Records (EMR) from GCUH. Patients’ underlying primary diagnosis and demographic data including the age and gender of the patients were collected. Main outcomes were the medications given to the patients for agitation, including the class, generic name and route. Results: Mean age was 64 ± 19 years, with 68% of patients being male. Administration of benzodiazepine was the most preferred way of managing agitated patients (45%), with oral the most common route for pharmacological management (47%). 5 patients (5%) were treated with 2 medications for their agitation and 8 patients (8%) were treated non‐pharmacologically using de‐escalation techniques. All patients with alcohol withdrawal syndrome were treated with benzodiazepine. When comparing among benzodiazepine, first‐generation antipsychotic use and second‐generation antipsychotics use on patients over the age of 65, 49% of these patients were on benzodiazepine for agitation, which was not consistent with the local guidelines. According to local guidelines, the first‐line pharmacological therapy for treating agitated patients over 65 years old is haloperidol unless in cases of alcohol withdrawal syndrome. Conclusion: Our review demonstrates a difference between the recommended current guidelines and clinical practice. We have not explored whether there was a difference in outcome of adverse events. We can recommend that this area needs further auditing to enable the development of new local protocols or changes to clinical practices.