Administering Parenteral Medications in Managing Patients with Acute Arousal in the Behavioral Assessment Unit of the Emergency Department in Hospital Settings.

IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL
Harshini M Liyanage, Katy Boyce, Yiting Gong, Theresa Koo, Soumitra Das, Naveen Thomas
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Abstract

Background/Objectives: The administration of parenteral medications is essential in managing acute arousal within the Behavioral Assessment Unit (BAU) of the emergency department (ED), where timely and effective intervention is critical. This study aims to evaluate current practices surrounding the use of parenteral medications for patients with acute agitation, focusing on adherence to protocols, medication safety, documentation accuracy, and patient outcomes. Methods: A retrospective analysis was conducted on 177 cases from December 2023 to February 2024. The study assessed the demographics, diagnoses, treatment protocols, and patient outcomes, with a particular emphasis on the use of parenteral medications such as benzodiazepines and antipsychotics. The relationship between medication administration and involuntary admission, mechanical restraint usage, and patient outcomes was also explored. Results: The majority of patients were aged between 21 and 30 years, and there was a predominance of male patients across both groups. Schizophrenia was the most common diagnosis, with a higher prevalence in the parenteral group (34%) compared to the oral-only group (24%), and personality disorders were more frequent in the parenteral group. Intramuscular (IM) medication administration was strongly associated with the use of mechanical restraint, with patients receiving IM medication being 35 times more likely to require restraint, emphasizing the link between more intensive treatment approaches and behavioral challenges. The most frequently administered medications were diazepam (40.6%) and olanzapine (36.5%), with olanzapine, droperidol, and diazepam most commonly used parenterally. Documentation of physical assessments prior to parenteral administration was present in most cases, though comprehensive evaluations such as ECGs were inconsistently performed. Conclusions: Parenteral medications, including benzodiazepines and antipsychotics, were effective in rapidly stabilizing patients, but the study emphasizes reducing dependency on mechanical restraints. Tailoring treatment to patient characteristics and employing alternative de-escalation strategies can improve safety and align with recovery-oriented care. This study highlights the need for evidence-based practices to optimize care and improve patient outcomes in ED settings. Further research is needed to explore long-term outcomes and refine non-coercive care approaches.

在医院急诊科行为评估单元管理急性觉醒患者时给予肠外药物治疗。
背景/目的:在急诊科(ED)的行为评估单元(BAU)内,给予肠外药物治疗对于管理急性唤醒至关重要,及时有效的干预至关重要。本研究旨在评估急性躁动患者使用肠外药物的现行做法,重点是遵守协议,药物安全性,文件准确性和患者预后。方法:对2023年12月~ 2024年2月收治的177例患者进行回顾性分析。该研究评估了人口统计学、诊断、治疗方案和患者结果,特别强调了苯二氮卓类药物和抗精神病药物等非肠外药物的使用。药物管理与非自愿入院、机械约束使用和患者预后之间的关系也进行了探讨。结果:患者年龄在21 ~ 30岁之间,两组均以男性患者为主。精神分裂症是最常见的诊断,肠外治疗组的患病率(34%)高于单纯口服治疗组(24%),而人格障碍在肠外治疗组更常见。肌内注射(IM)药物管理与机械约束的使用密切相关,接受IM药物治疗的患者需要约束的可能性高出35倍,强调了更强化的治疗方法与行为挑战之间的联系。最常用的药物是地西泮(40.6%)和奥氮平(36.5%),其中奥氮平、氟哌啶醇和地西泮最常用于肠外注射。在大多数病例中,在肠外给药之前都有身体评估的记录,尽管心电图等综合评估的执行不一致。结论:静脉注射药物,包括苯二氮卓类药物和抗精神病药物,对快速稳定患者是有效的,但研究强调减少对机械约束的依赖。根据患者特点定制治疗并采用替代性的降级策略可以提高安全性,并与以康复为导向的护理相一致。本研究强调需要循证实践来优化护理和改善急诊科患者的预后。需要进一步的研究来探索长期结果和改进非强制护理方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinics and Practice
Clinics and Practice MEDICINE, GENERAL & INTERNAL-
CiteScore
2.60
自引率
4.30%
发文量
91
审稿时长
10 weeks
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