A Quality Improvement Project on Agitation Management in the Emergency Department

Area of Science:

• Emergency Medicine
• Behavioral Health
• Quality Improvement

Background:

• Patient agitation is a frequent challenge in emergency departments, often leading to restraint use and patient injury if not managed early.
• Early detection and effective management of agitation are crucial for patient safety and reducing adverse outcomes.

Purpose of the Study:

• To evaluate the early detection and management of patient agitation.
• To reduce the use of restraints in the emergency department.
• To determine the usability of the Behavioral Activity Rating Scale (BARS) among emergency nurses.

Main Methods:

• A quality improvement project utilizing a pre- and posttest single unit design.
• Implementation of the Behavioral Activity Rating Scale (BARS) within the electronic medical record.
• Data collection through retrospective chart review and nurse surveys (System Usability Scale).

Main Results:

• The Behavioral Activity Rating Scale (BARS) was frequently documented by nurses for patients with behavioral health and medical complaints.
• While restraint use showed a nonsignificant difference, the duration of restraint was reduced in the post-implementation year.
• Emergency nurses found the Behavioral Activity Rating Scale (BARS) to be a usable tool.

Conclusions:

• The Behavioral Activity Rating Scale (BARS) is a practical and usable tool for emergency nurses in assessing patient agitation.
• Integrating agitation management interventions alongside the BARS can help manage agitation before it escalates to violence.
• Further research is recommended on agitation assessment tools for managing behavioral activity in emergency settings.