When the Patient Is Agitated, What Do You Do? Article Offers Strategies

​Healthcare providers can take several steps to manage patient agitation and keep the situation from escalating, according to an article in the March 2018 issue of the Journal of Family Practice. An initial step, the authors note, is to define the problem and evaluate the severity. The authors identified four categories of causes of agitation: medical conditions (e.g., pain, hypoglycemia, sepsis), psychiatric conditions (e.g., dementia, psychosis, personality disorder), intoxication or withdrawal (e.g., alcohol, stimulants, toxins), and iatrogenic causes (e.g., sedation, drug interactions, long wait times). These categories may overlap. Tools can be used to assess patients for level of agitation, such as the Agitated Behavior Scale or the Behavioural Activity Rating Scale, and risk for violence, such as the ABC risk assessment. For situations in which the patient is agitated, the authors share four "general tenets of de-escalation": stay calm (e.g., use a calm tone and body language), be nonconfrontational (e.g., ask open-ended questions, listen to the patient, acknowledge the patient's perceptions), assess available resources (e.g., family members, clinical staff, security, silent alarms), and manage the patient's underlying needs and manage the situation (e.g., work with the patient to identify strategies, refer the patient if necessary). The article also discusses considerations and tips for a variety of healthcare settings.