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Management of behavioural emergencies: a prospective observational study in Australian emergency departments
Author(s) -
Yap Celene Y. L.,
Taylor David McD.,
Kong David C. M.,
Knott Jonathan C.,
Taylor Simone E.,
Graudins Andis,
Keijzers Gerben,
Kulawickrama Sanjeewa,
Thom Ogilvie,
Lawton Luke,
Furyk Jeremy,
Finucci Daniel,
Holdgate Anna,
Watkins Gina,
Jordan Peter
Publication year - 2019
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/jppr.1522
Subject(s) - medicine , sedation , droperidol , emergency department , midazolam , sedative , observational study , adverse effect , prospective cohort study , emergency medicine , incidence (geometry) , pediatrics , anesthesia , vomiting , surgery , psychiatry , physics , optics
Background Behavioural emergencies (BEs) are complex situations in the emergency department (ED) setting. Treatment decisions always must be made within a limited time and are based on incomplete patient data. As a result of the urgency and complexity, patients often are exposed to increased risk of harm. Aim The aim of this paper is to describe the prescribing patterns and adverse events ( AE s) associated with parenteral sedation for the management of BE s in Australian ED s. Methods Ten Australian ED s enrolled a convenience sample of adult patients (aged ≥18 years) requiring parenteral sedative medication for BE s. Data were collected prospectively between March 2015 and April 2017 using a designated case report form. Results In all, 564 cases were enrolled in this study. Incomplete cases ( n = 17; 3%) were excluded. Of the 547 remaining cases, 63% were male and the median age was 34 years (range 18–95 years). Approximately half the patients ( n = 230; 42.1%) required mechanical restraint and parenteral sedation to manage their BE s. Intramuscular monotherapy was administered in most cases ( n = 390; 71.3%). The main sedative medications used as monotherapy were droperidol ( n = 381; 69.7%), midazolam ( n = 54; 9.9%) and olanzapine ( n = 26; 4.8%). The most common combination therapy was midazolam + droperidol ( n = 36; 6.6%). The incidence of AE s from sedative administration was 13.5%. No deaths or irreversible AE s were reported. Conclusions Overall, the participating ED s provided safe pharmacological management for BE s. AE s following parenteral sedation are common, although serious AE s are rare. Because all patients receiving parenteral sedation for BE s are at risk of AE s, ongoing monitoring of vital signs after parenteral sedation should be a standard protocol in all ED s.