Best Practice Guidelines For Agitated Patients

Mar 30, 2012

Agitation can be displayed in patients as loud, disruptive, hostile, sarcastic, threatening, hyperactive, and/or combative. Here are tips on managing agitated patients.

Project BETA-an acronym for Best practices in Evaluation and Treatment of Agitation-incorporates humane, patient-centered interventions when dealing with agitated patients. The recommendations are endorsed as part of the new, comprehensive best practices guidelines under the auspices of the American Association for Emergency Psychiatry (AAEP). Below is a partial list.



Definition: Agitation is defined as "excessive verbal and/or motor behavior" that can be loud, disruptive, hostile, sarcastic, threatening, hyperactive, and/or combative

Keep these points in mind

• Guidelines for treatment include the entire agitation clinical spectrum, including triage, diagnosis, and interpersonal calming skills, as well as medicine choices.

•De-escalation can work far more often than many clinicians might be aware

• It is nearly always worth attempting verbal calming as part of an agitation treatment approach

• Patients should be encouraged to take oral medications voluntarily, as opposed to forcible involuntary injections. This will enhance the therapeutic alliance

• Second-generation antipsychotics are as efficacious as first-generation antipsychotics in agitation, and preferable because of side effect profiles

• Agitation from stimulant intoxication should be treated with benzodiazepines alone

• Myth: Emergency programs that reduce the use of restraints result in more staff assaults. These programs frequently have fewer staff assaults and injuries

Note: Adapted from a Psychiatric Times article by Scott Zeller, MD, titled "New Guidelines Shake Up Treatment of Agitation."