Implementation of an Agitation Scale in Three Emergency Departments in an Urban Area of Northern California

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay. Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff. Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff. Interventions. An evidenced-based agitation scale was implemented in three emergency departments to introduce more therapeutic patient-centered care to the ED nurse workflow. Outcome Measures. Frequency of Code Grey activations, physical restraint placement, and emergent sedation medication administration were measured pre, mid, and post-intervention. Prior year data for the corresponding months of the intervention was compared. Results. Implementation of the agitation scale reduced the frequency of Code Grey activations and administration of emergent sedation medication from mid-point to post-implementation in all three emergency departments. Four-point restraint use decreased from the prior year but was relatively stable over the duration of agitation scale implementation. Conclusions. The incorporation of an agitation scale into nurse workflow provided an opportunity for earlier intervention and a path to more therapeutic patient-centered care