From the Guidelines
Non-sedation methods for managing agitation prioritize verbal restraint strategies, environmental modifications, and behavioral techniques to address underlying causes without inducing drowsiness. These approaches are crucial in maintaining the patient's functionality and quality of life. Key strategies include:
- Verbal restraint strategies, such as respecting personal space, minimizing provocative behavior, establishing verbal contact, being concise, identifying patient's goals and expectations, using active listening, agreeing or agreeing to disagree, setting clear limits and expectations, offering choices and optimism, and debriefing patient and staff 1
- Environmental modifications, including creating a calm setting, reducing noise and stimulation, ensuring proper lighting, and maintaining a consistent routine 1
- Behavioral techniques like de-escalation, redirection, validation therapy, and reality orientation can be effective in managing agitation without sedation
- Physical comfort measures should address pain, hunger, thirst, and toileting needs to prevent agitation triggers These non-sedation approaches are particularly important for vulnerable populations, such as elderly patients and those with dementia, where sedation can increase fall risk, cognitive impairment, and delirium. By prioritizing these methods, healthcare providers can effectively manage agitation while maintaining the patient's quality of life and functionality.
From the Research
Non-Sedation Methods for Managing Agitation
- Verbal de-escalation is a key method for managing agitation, involving a 3-step approach: verbal engagement, establishing a collaborative relationship, and verbal de-escalation out of the agitated state 2
- Non-coercive de-escalation strategies should be used as the first step in managing agitation, with the goal of avoiding the use of restraint and coercive interventions that can escalate agitation 3, 2
- Nonverbal approaches, such as voluntary medication and environment planning, can also be effective in managing agitation 2
- The primary objectives when working with an agitated patient are to ensure safety, help the patient manage their emotions and distress, avoid the use of restraint, and avoid coercive interventions 2
- De-escalation without medication or physical restraint should be the preferred endpoint of an intervention in agitation, with calming without sedation being the most advised endpoint of intervention 4
Key Principles
- Patient autonomy, safety, and medical well-being are paramount when managing agitation 3
- A step-wise approach to managing agitation, beginning with non-coercive de-escalation strategies and moving on to pharmacologic interventions and physical restraints as necessary, is recommended 3
- The use of pharmacologic interventions, such as haloperidol and benzodiazepines, should be considered, but the selection of a specific agent should be guided by etiologic considerations, efficacy, side effects, and potential drug interactions 5, 6