The impact of a standardised intramuscular sedation protocol for acute behavioural disturbance in the emergency department

Abstract

BackgroundAcute behavioural disturbance (ABD) is an increasing problem in emergency departments. This study aimed to determine the impact of a structured intramuscular (IM) sedation protocol on the duration of ABD in the emergency department.MethodsA historical control study was undertaken comparing 58 patients who required physical restraint and parenteral sedation with the structured IM sedation protocol, to 73 historical controls treated predominantly by intravenous sedation, according to individual clinician preference. The primary outcome was the duration of the ABD defined as the time security staff were required. Secondary outcomes were the requirement for additional sedation, drug related-adverse effects and patient and staff injuries.ResultsThe median duration of the ABD in patients with the new sedation protocol was 21 minutes (IQR: 15 to 35 minutes; Range: 5 to 78 minutes) compared to a median duration of 30 minutes (IQR: 15 to 50 minutes; Range: 5 to 135 minutes) in the historical controls which was significantly different (p = 0.03). With IM sedation only 27 of 58 patients (47%; 95% CI: 34% to 60%) required further sedation compared to 64 of 73 historical controls (88%; 95%CI: 77% to 94%). There were six (10%) drug-related adverse events with the new IM protocol [oxygen desaturation (5), oxygen desaturation/airway obstruction (1)] compared to 10 (14%) in the historical controls [oxygen desaturation (5), hypoventilation (4) and aspiration (1)]. Injuries to staff occurred with three patients using the new sedation protocol and in seven of the historical controls. Two patients were injured during the new protocol and two of the historical controls.ConclusionThe use of a standardised IM sedation protocol was simple, more effective and as safe for management of ABD compared to predominantly intravenous sedation.

Treatment and outcomes of patients presenting to an adult emergency department involuntarily with substance misuse

“…It is believed that the high number of patients requiring this treatment is reflective of the involuntary nature of the presentation in the ED. In line with previous work conducted in the studied department and other departments, droperidol was the first-line agent in all of these patients (Calver et al 2010(Calver et al , 2015.…”

“…In line with previous work conducted in the studied department and other departments, droperidol was the first‐line agent in all of these patients (Calver et al . , ).…”

Population pharmacokinetics of intramuscular droperidol in acutely agitated patients

“…Five of the 41 patients were given additional sedation with droperidol and 90% were sedated within 36 min. There were 128 samples available for analysis from the 41 patients with a median of three samples per patient (1)(2)(3)(4)(5)(6)(7). Four observations were below the lower limit of quantitation of 5 μg l -1 .…”

“…Violence and aggression in hospitalised patients is a growing problem faced by emergency departments and psychiatric units [2][3][4][5][6][7]. This type of patient behaviour poses significant risks for patients and staff and can cause personal injury or damage to hospital property.…”

“…This may result in needle stick injuries or failed attempts at gaining IV access. Intramuscular (IM) administration of sedative drugs, benzodiazepines or antipsychotics, has become the preferred route of administration for these acutely agitated patients in emergency departments [2]. However, there has always been concerns that there will be a delayed onset of effect with IM administration because the medication has to be absorbed first.…”