Oral Medications for Treating Agitation in a Safety Net Emergency Department

Area of Science:

• Emergency Medicine
• Pharmacology
• Quality Improvement

Background:

• Best-practice guidelines advocate oral medications for emergency department (ED) agitation.
• Limited research exists on oral medication use in EDs, particularly for drug and alcohol intoxication.
• Intramuscular medications were the standard for agitation treatment in the studied ED.

Purpose of the Study:

• To evaluate the implementation of oral medications for agitation treatment in an ED.
• To increase the utilization of oral medications over intramuscular routes for agitation.
• To assess the effectiveness and safety of oral versus intramuscular medications for agitation.

Main Methods:

• A quality improvement study comparing pre- and post-intervention periods (2018-2024) in an urban trauma center ED.
• Prospective observation during a 12-month implementation period (2020-2021) in a dedicated intoxication care area.
• Education and real-time feedback were used to encourage oral medication (e.g., olanzapine, lorazepam) use by ED staff.

Main Results:

• The proportion of patients receiving their first sedating medication orally increased significantly from 7.2% to 31.4% post-intervention.
• During implementation, 53.5% of eligible patients were offered oral medication, with 70.8% accepting it.
• No significant differences were observed in time to adequate sedation, additional rescue medication rates, or adverse drug reactions between oral and intramuscular routes.

Conclusions:

• Emergency physicians successfully adopted oral medications for agitation, particularly in intoxication cases.
• Oral and intramuscular medications demonstrated comparable efficacy and safety profiles for agitation management.
• Findings support current guidelines recommending oral medications as the first-line treatment for ED agitation.