Liyanage Harshini M, Boyce Katy, Gong Yiting, Koo Theresa, Das Soumitra, Thomas Naveen
Western Health, Melbourne 3021, Australia.
The Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne 3010, Australia.
Clin Pract. 2025 Jun 16;15(6):112. doi: 10.3390/clinpract15060112.
: The administration of parenteral medications is essential in managing acute arousal within the Behavioral Assessment Unit (BAU) of the emergency department (ED), where timely and effective intervention is critical. This study aims to evaluate current practices surrounding the use of parenteral medications for patients with acute agitation, focusing on adherence to protocols, medication safety, documentation accuracy, and patient outcomes. : A retrospective analysis was conducted on 177 cases from December 2023 to February 2024. The study assessed the demographics, diagnoses, treatment protocols, and patient outcomes, with a particular emphasis on the use of parenteral medications such as benzodiazepines and antipsychotics. The relationship between medication administration and involuntary admission, mechanical restraint usage, and patient outcomes was also explored. : The majority of patients were aged between 21 and 30 years, and there was a predominance of male patients across both groups. Schizophrenia was the most common diagnosis, with a higher prevalence in the parenteral group (34%) compared to the oral-only group (24%), and personality disorders were more frequent in the parenteral group. Intramuscular (IM) medication administration was strongly associated with the use of mechanical restraint, with patients receiving IM medication being 35 times more likely to require restraint, emphasizing the link between more intensive treatment approaches and behavioral challenges. The most frequently administered medications were diazepam (40.6%) and olanzapine (36.5%), with olanzapine, droperidol, and diazepam most commonly used parenterally. Documentation of physical assessments prior to parenteral administration was present in most cases, though comprehensive evaluations such as ECGs were inconsistently performed. : Parenteral medications, including benzodiazepines and antipsychotics, were effective in rapidly stabilizing patients, but the study emphasizes reducing dependency on mechanical restraints. Tailoring treatment to patient characteristics and employing alternative de-escalation strategies can improve safety and align with recovery-oriented care. This study highlights the need for evidence-based practices to optimize care and improve patient outcomes in ED settings. Further research is needed to explore long-term outcomes and refine non-coercive care approaches.
在急诊科（ED）的行为评估单元（BAU）中，胃肠外给药对于处理急性激惹状态至关重要，在此及时有效的干预至关重要。本研究旨在评估当前针对急性激越患者使用胃肠外药物的实践情况，重点关注方案的依从性、用药安全性、记录准确性和患者结局。
对2023年12月至2024年2月期间的177例病例进行了回顾性分析。该研究评估了人口统计学特征、诊断、治疗方案和患者结局，特别强调了苯二氮䓬类和抗精神病药物等胃肠外药物的使用情况。还探讨了药物给药与非自愿住院、使用机械约束以及患者结局之间的关系。
大多数患者年龄在21至30岁之间，两组中男性患者居多。精神分裂症是最常见的诊断，胃肠外给药组的患病率（34%）高于仅口服给药组（24%），人格障碍在胃肠外给药组中更为常见。肌内（IM）给药与使用机械约束密切相关，接受IM给药的患者需要约束的可能性高出35倍，这强调了更强化治疗方法与行为挑战之间的联系。最常使用的药物是地西泮（40.6%）和奥氮平（36.5%），奥氮平、氟哌利多和地西泮是最常用的胃肠外给药药物。大多数情况下在胃肠外给药前有体格检查记录，不过心电图等全面评估的执行情况并不一致。
包括苯二氮䓬类和抗精神病药物在内的胃肠外药物在迅速稳定患者方面有效，但该研究强调减少对机械约束的依赖。根据患者特征调整治疗并采用替代的降级策略可以提高安全性，并符合以康复为导向的护理。本研究强调在急诊科环境中需要基于证据的实践来优化护理并改善患者结局。需要进一步研究以探索长期结局并完善非强制性护理方法。
