Pathway Background and Objectives
Acute agitation in the hospital setting can be dangerous and highly distressing for patients, families, and staff. Further, it can result in disruption of care, injury, and need for chemical or physical restraint. Management of agitation requires understanding of its etiology and implementation of environmental, behavioral, and pharmacological interventions.
The objectives of this pathway are to:
- Recognize early signs of agitation and emphasize behavioral and environmental de-escalation first
- Standardize the medical management of agitation
- Avoid the overuse of medication to manage agitation
- Reduce the frequency of physical restraints used for agitation management
- Check our own implicit biases
For management of this condition in primary care, see CLASP/Co-Management guideline
Attention: Critical Shortage of IV Lorazepam Nationwide
This is anticipated to be a long term shortage. In order to preserve the limited supplies, please consider using the following alternatives to Lorazepam IV:
- Lorazepam oral
- ODT/IM olanzapine in settings of escalating agitation EXCEPT for Anticholinergic syndrome/toxidrome, emergent agent in catatonia unless specific recommendations detail otherwise
- IM or IV diphenhydramine EXCEPT for Anticholinergic syndrome/toxidrome, Delirium, History of paradoxical reaction to diphenhydramine