Name: Evaluation of Implementation of an Agitation Protocol in an Emergency Department
Start: 2026-05-19T10:30:00-0400
End: 2026-05-19T10:50:00-0400

Evaluation of Implementation of an Agitation Protocol in an Emergency Department

Tuesday May 19, 2026 10:30am - 10:50am EDT

Broad Hub EAST

Purpose
This study evaluates the implementation of an ED agitation protocol on the reduction of repeat sedative doses within 1 hr in agitated adults, leading to safer, more effective agent selection and evidence-based pharmacologic management.
Methods
This multi-center retrospective chart review evaluated electronic medical records of adult ED patients across all LVHN sites who were treated with at least one dose of sedative medication for agitation. Patients treated from 7/1/2022–7/1/2023 and 10/1/2023–10/1/2024 were identified, stratified by study period, and randomly selected to be included for analysis. Patients who were not treated for acute agitation, had alternative indications for benzodiazepines, (Ex. CIWA benzodiazepines), or had a pre-administration SPO₂<92% or SBP< 90 were excluded from analysis. Variables collected included medication selection, times of medication administration, ED LOS, patient disposition, and safety data. A sample size of 169 patients per group was calculated to detect 15% differences in repeat sedative use (49% vs 34%) using a two-tailed chi-square test (α=0.05, power=80%).
Results
Baseline characteristics were similar amongst groups. Agent treatment selection was similar pre- and post-protocol implementation. The proportion of patients requiring an additional sedative within 1 hour significantly decreased post-protocol implementation (8.9% vs 17%, p=0.025). ED length of stay was significantly reduced (20 h vs 25 h, p=0.00006). The proportion of patients requiring 1:1 monitoring before and after implementation was (31% vs 39%, p=0.096), a reduction in 8%. Restraint use decreased by 13% post-implementation (31% vs 43%). ICU admission rates did not differ between groups (p=0.769). Adverse events were infrequent, limiting conclusions. Diphenhydramine use was not associated with ED LOS.
Conclusion
Adoption of a standardized ED agitation protocol was associated with fewer repeat sedative doses within one hour and a reduction in emergency department length of stay. These improvements occurred without increases in ICU admission, monitoring needs, or adverse events. Protocol-driven, evidence-based medication selection enhances initial agitation control, reduces restraint use, improves patient safety, and promotes more efficient care delivery.

Moderators

Jessica Clancy

Nicholas Ferraro, PharmD, BCPS

PGY1 RPD & Clinical Pharmacy Specialist: IM/TOC, Temple University Hospital - Main Campus

Speakers

Zachary Balodis

PGY1, Lehigh Valley Health Network - Cedar Crest

Zachary Balodis attended pharmacy school at Thomas Jefferson University in 2025. He is now completing a PGY1 at Lehigh Valley Health Network - Cedar Crest in Allentown, PA. His major areas of clinical interest include emergency medicine, critical care, and transplant. After completion... Read More →

Tuesday May 19, 2026 10:30am - 10:50am EDT
Broad Hub EAST

Medication Safety/Quality Improvement

PSHP 2026 Residency Conference

Jessica Clancy

Nicholas Ferraro, PharmD, BCPS

Zachary Balodis

Attendees (10)

Get help with the event

PSHP 2026 Residency Conference

Jessica Clancy

Nicholas Ferraro, PharmD, BCPS

Zachary Balodis

Attendees (10)

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