scholarly journals Which Emergent Medication Should I Give Next? Repeated Use of Emergent Medications to Treat Acute Agitation

2021 ◽  
Vol 12 ◽  
Author(s):  
Veronica B. Searles Quick ◽  
Ellen D. Herbst ◽  
Raj K. Kalapatapu
Keyword(s):  
Medication Administration ◽  
Psychiatric Emergency ◽  
Common Symptom ◽  
Initial Management ◽  
Oral Medications ◽  
Acute Agitation ◽  
Repeated Use ◽  
Medication Intervention ◽  
Clinical Algorithms ◽  
Initial Medication

Agitation is a common symptom encountered among patients treated in psychiatric emergency settings. While there are many guidelines available for initial management of the acutely agitated patient, there is a notable dearth of guidelines that delineate recommended approaches to the acutely agitated patient in whom an initial medication intervention has failed. This manuscript aims to fill this gap by examining evidence available in the literature and providing clinical algorithms suggested by the authors for sequential medication administration in patients with persistent acute agitation in psychiatric emergency settings. We discuss risk factors for medication-related adverse events and provide options for patients who are able to take oral medications and for patients who require parenteral intervention. We conclude with a discussion of the current need for well-designed studies that examine sequential medication options in patients with persistent acute agitation.

Letters

2006 ◽  
Vol 25 (3) ◽  
pp. 187-187
Author(s):  
Lorraine Harbold ◽  
Julie Appel ◽  
David Copelan
Keyword(s):  
Enteral Nutrition ◽  
Safety Concern ◽  
Medication Administration ◽  
Contributing Factors ◽  
Administration System ◽  
Feeding Tubes ◽  
Oral Medications ◽  
Unit Dose

I read with interest, the January/February, 2006 (Vol. 25, No. 1) article, “Implementation of an Enteral Nutrition and Medication Administration System Utilizing Oral Syringes in the NICU.” The inadvertent administration of an enteral product intravenously is certainly a safety concern for all NICUs. Our institution began addressing this more than a decade ago by first converting all oral medications to a unit dose system dispensed only in oral syringes. I was surprised by the incompatibility between oral syringes and orogastric, nasogastric, or nasojejunal tubes, cited by the authors, as one of the contributing factors in preventing them from making this conversion. Over the years we have used several brands of NG/OG tubes that easily accommodate the intermittent use of oral syringes. They do not have luer-lok hubs that preclude the use of an oral syringe. The feeding tubes that we generally use for transpyloric placement (duodenal/jejunal), often have a medication port that easily accommodates an oral syringe.

Abstract TP388: Improved Dysphagia Screening Compliance of Stroke Patients With an Emergency Department Focus

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Danyell Williams ◽  
Kelly Elliott ◽  
Rachel Leicht
Keyword(s):  
High Risk ◽  
Acute Care ◽  
Aspiration Pneumonia ◽  
Screening Tool ◽  
Oral Intake ◽  
Medication Administration ◽  
High Risk Population ◽  
Common Symptom ◽  
Stroke Patients ◽  
Standardized Screening

Background and Issues: A common symptom of stroke, dysphagia leaves patients vulnerable to aspiration pneumonia and at risk for poor outcomes, mortality, and increased length of stay and healthcare costs. Evidence-based practice indicates early detection of dysphagia is fundamental in decreasing the risk of aspiration, yet often the opportunity is missed in the process of providing emergent care. Stroke patients should be screened for dysphagia and aspiration risk upon ED arrival using a standardized tool before receiving oral intake. Purpose: The goal was to emphasize early dysphagia screening with a standardized screening tool, achieving ≥ 85% compliance in this high-risk population. Methods: Cause-and-effect analysis was used throughout the improvement initiative. Focus was applied to staff recognition of stroke patients as high risk for dysphagia and associated complications. A standardized screening tool was adopted. Missed screening opportunities were identified, revealing frequent association with time-sensitive medication administration of antithrombotics in the ED. A six month pilot was conducted in the ED; an alert was programmed into the medication dispensing station to query the user regarding patient dysphagia risk when specific antithrombotics were dispensed. Control charts were used to measure compliance. Results: Screening compliance significantly improved more than 23% from 1Q2016 to 1Q2019. The standardized screening tool supported inter-rater reliability. The ED pilot improved compliance to 88%, revealing opportunities to improve screening compliance in acute care units. Conclusions: A standardized screening tool and medication alert in the ED improved dysphagia screen compliance, suggesting similar outcomes if implemented on acute care units. Further data will be valuable to hypothesize a negative correlation between sustained dysphagia screening compliance and decreased incidence of healthcare-associated aspiration pneumonia.

Implementation of an Enteral Nutrition and Medication Administration System Utilizing Oral Syringes in the NICU

2006 ◽  
Vol 25 (1) ◽  
pp. 21-24 ◽  
Author(s):  
David Copelan ◽  
Julie Appel
Keyword(s):  
Medication Administration ◽  
Patient Specific ◽  
Syringe Pump ◽  
Process Change ◽  
Administration System ◽  
Oral Medications ◽  
Change In Practice ◽  
Check System ◽  
Unit Dose ◽  
Enteral Formulas

NICU patients are at particularly high risk of harm and even death from medical error. In one NICU, a process change was undertaken to minimize the risk of errors resulting in the intravenous (IV) administration of enteral formulas and oral medications. In addition, a double-check system for medication doses was introduced to reduce the likelihood of medication errors. The previous practice was to deliver enteral formulas via syringe pump using IV syringes and tubing and to dispense medications in bulk bottles, drawing up patient-specific doses at the bedside. Converting to oral syringe delivery of medications and enteral formulas utilizing enteral-only tubing eliminated the necessity for Luer-Lok IV tubing and syringes, thereby reducing the potential for wrong-route error. Converting from dispensing medications in bulk to a unit-dose system permitted establishment of a double- check system in which doses are first checked by a pharmacist and then checked by the nurse before they are administered. This article describes the planning, implementation, and postimplementation process required to make this change in practice a success.

Repeated Use of Psychiatric Emergency Services by Children

1991 ◽  
Vol 36 (10) ◽  
pp. 739-742 ◽  
Author(s):  
W. Cole ◽  
A. Turgay ◽  
G. Mouldey
Keyword(s):  
Emergency Services ◽  
Significant Proportion ◽  
Adjustment Disorder ◽  
Psychiatric Emergency ◽  
Emergency Rooms ◽  
Psychiatric Emergency Services ◽  
Child Psychiatric ◽  
Repeated Use ◽  
The One

In this study, the repeat utilization of child psychiatric emergency services was examined. There are patients who use psychiatric emergency services repeatedly, and these patients represent a significant proportion of child psychiatric emergencies seen in emergency rooms. Repeat patients were more likely to threaten to harm others, have a diagnosis of adjustment disorder, conduct or oppositional disorder and be under the care of a child welfare agency. They were significantly more likely than the one-time patients to be less compliant with outpatient follow-up, admitted to hospital more often, needed more social support and had greater difficulty remaining in a residential treatment setting. Intervention in the emergency room did not appear to change the way they used emergency services.

Intramuscular Ziprasidone Dosing for Acute Agitation in the Pediatric Emergency Department: An Observational Study

2017 ◽  
Vol 31 (1) ◽  
pp. 18-21 ◽  
Author(s):  
Tammy Nguyen ◽  
Jillian Stanton ◽  
Robin Foster
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Initial Dose ◽  
Clinical Information ◽  
Pediatric Emergency ◽  
Limited Data ◽  
Old Patients ◽  
Acute Agitation ◽  
Medication Intervention ◽  
Dose Difference

Background: Intramuscular (IM) ziprasidone is often used to manage acute agitation. Limited data exist on the pediatric dosing of ziprasidone in the emergency department (ED). Objective: To characterize the mg/kg dosing differences between pediatric ED patients who respond to an initial dose of ziprasidone versus patients who do not. Methods: This was a retrospective, observational study of 5- to 18-year-old patients who were treated with IM ziprasidone in the pediatric ED from 2007 to 2015. Medical records were reviewed to determine demographic and clinical information. Patients were deemed responders to ziprasidone if they required no additional rescue medication for acute agitation within 30 minutes of the initial dose. Results: Forty children received 50 doses of IM ziprasidone. Twenty-seven (68%) patients responded to the initial ziprasidone dose, requiring no further medication intervention for their acute agitation. Responders were given a mean initial dose of 0.19 ± 0.1 mg/kg, while nonresponders were given an initial mean dose of 0.13 ± 0.06 mg/kg ( P = .03). Conclusion: A significant dose difference exists between patients who required only one initial dose of ziprasidone compared to those who required additional medication. As a result, an initial dose of 0.2 mg/kg of IM ziprasidone may be considered when managing acutely agitated pediatric patients in the ED.

scholarly journals Quality improvement of intravenous to oral medication conversion using Lean Six Sigma methodologies

2020 ◽  
Vol 9 (1) ◽  
pp. e000804
Author(s):  
Julie Downen ◽  
Cassie Jaeger
Keyword(s):  
Conversion Rate ◽  
Medication Administration ◽  
Lean Six Sigma ◽  
Oral Medication ◽  
Missed Opportunities ◽  
Oral Medications ◽  
Medication Costs ◽  
Increased Risk ◽  
Delayed Discharges ◽  
Missed Opportunity

IntroductionLack of medication conversion from intravenous to oral contributes to increased risk of infection, delayed discharges and higher medication costs. At our institution, intravenous to oral medication conversion rate was 76% with missed opportunity for conversion of 37%. The goal of the project was to reduce the percent of missed opportunities for intravenous to oral conversion for applicable medications.MethodsA pharmacy-driven intravenous to oral policy and procedure was implemented. To identify potential opportunities, a patient worklist of applicable intravenous to oral medications was created for pharmacy review in real time. An intravenous to oral conversion order was implemented in the computerised provider order entry. ‘Convert to oral’ was added as an option in the electronic medication request and highlighted reminders were added to the electronic medication administration record for eligible medications.ResultsAfter improvements, the missed opportunity rate for intravenous to oral conversion decreased from 37% (19/51) to 21% (24/113) (p=0.04, two-proportion test), a 43% improvement. The trend in intravenous to oral conversion rate increased from 76% (39/51) to 85% (171/201) and severity adjusted length of stay was reduced from 8.1 days to 6.4 days post improvements (p<0.001, t-test).

scholarly journals Occipital Nerve Blocks in the Emergency Department for Initial Medication-Refractory Acute Occipital Migraines

2019 ◽  
Vol 3 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Justin Yanuck ◽  
Sagar Shah ◽  
Maxwell Jen ◽  
Rakhi Dayal
Keyword(s):  
Case Series ◽  
Medication Administration ◽  
Occipital Region ◽  
First Line ◽  
Nerve Blocks ◽  
Occipital Nerve ◽  
Chief Complaints ◽  
Initial Medication ◽  
First Line Treatment

Migraines are consistently among the top 20 primary coded diagnoses in emergency departments, constituting 4.5% of all chief complaints. In a significant subset of these, pain arises from the occipital region innervated by the greater (GON) and lesser occipital nerve. In this case series, we present three patients with occipital migraines who received GON blockade with 1% lidocaine. The blockade was performed only after first-line treatment with metoclopramide and possibly additional medications as ordered by triage physician, failed to adequately alleviate pain by 40 minutes after medication administration. Patients were contacted a minimum of seven days following treatment. All three patients experienced significant analgesia and relief of symptoms within 15 minutes of blockade and sustained relief through a seven-day follow-up period.

Are Oral Medications Effective in the Management of Acute Agitation?

2012 ◽  
Vol 43 (5) ◽  
pp. 854-859 ◽  
Author(s):  
Travis I. Gault ◽  
Siobhan M. Gray ◽  
Gary M. Vilke ◽  
Michael P. Wilson
Keyword(s):  
Oral Medications ◽  
Acute Agitation
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