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3 results

  • Chapter 2 - Disruptive and Dangerous Agitation

  • Edited by Mark Curato, Weill Cornell Medicine, New York, Kaushal Shah, Weill Cornell Medicine, New York, Christopher Reisig, Weill Cornell Medicine, New York
  • Book:
    Urban Emergency Medicine
    Published online:
    20 July 2023
    Print publication:
    03 August 2023, pp 13-25

  • Summary

    Agitation is a cardinal emergency medicine and prehospital presentation and occurs across a spectrum of severity and risk. Moderately agitated patients can be adequately assessed to exclude dangerous conditions, and if verbal de-escalation fails, may be treated with small doses of a titratable sedative or combination of sedatives, repeated as needed to calm the patient. Dangerously severe agitation is an uncommon medical emergency requiring prompt recognition and treatment in a high-resource care setting. Management focuses on the immediate treatment of agitation so that the patient and others are protected from uncontrolled violence, and so that dangerous causes and effects of agitation are quickly identified and addressed. Once adequate personnel are assembled to safely approach and subdue the patient, face mask oxygen is applied and dangerous restraint holds are relieved. Maximally effective calming medications are administered intramuscularly to quickly treat agitation. As the patient calms, resuscitation-level monitoring and care proceeds, with particular attention to ventilation, as the range of immediately dangerous causes and consequences of agitation are addressed.

  • Is an unhealthy work environment in nursing home care for people with dementia associated with the prescription of psychotropic drugs and physical restraints?

  • Bernadette M. Willemse, Jan de Jonge, Dieneke Smit, Wouter Dasselaar, Marja F. I. A. Depla, Anne Margriet Pot
  • Journal:
    International Psychogeriatrics / Volume 28 / Issue 6 / June 2016
    Published online by Cambridge University Press:
    02 February 2016, pp. 983-994
  • Background:

    Research showed that long-term care facilities differ widely in the use of psychotropic drugs and physical restraints. The aim of this study is to investigate whether characteristics of an unhealthy work environment in facilities for people with dementia are associated with more prescription of psychotropic drugs and physical restraints.

    Methods:

    Data were derived from the first wave (2008–2009) of a national monitoring study in the Netherlands. This paper used data on prescription of psychotropic drugs and physical restraints from 111 long-term care facilities, residing 4,796 residents. Survey data of a sample of 996 staff and 1,138 residents were considered. The number of residents with prescribed benzodiazepines and anti-psychotic drugs, and physical restraints were registered. Work environment was assessed using the Leiden Quality of Work Questionnaire (LQWQ).

    Results:

    Logistic regression analyses showed that more supervisor support was associated with less prescription of benzodiazepines. Coworker support was found to be related to less prescription of deep chairs. Job demands and decision authority were not found to be predictors of psychotropic drugs and physical restraints.

    Conclusions:

    Staff's job characteristics were scarcely related to the prescription of psychotropic drugs and physical restraints. This finding indicates that in facilities with an unhealthy work environment for nursing staff, one is not more likely to prescribe drugs or restraints. Further longitudinal research is needed with special attention for multidisciplinary decision making – especially role of physician, staff's knowledge, philosophy of care and institutional policy to gain further insight into factors influencing the use of psychotropic drugs and restraints.