PSHP 2026 Residency Conference

Purpose: Evaluate the impact of provider education on the initial selection of medications used to treat patients with escalating agitation in acute care settings to ensure staff and patient safety.
Methods: A two-phase retrospective chart review study evaluated the impact of provider education on medication selection for agitated patients aged 18 and older who required an institutional agitation alert and received stat medications for agitation. Phase one retrospectively identified these patients during a six-month period prior to the intervention. In phase two, providers received an educational presentation detailing the recommendations from an algorithm collaboratively created by clinical pharmacists and psychiatric providers for treatment of acutely agitated and violent patients. Post-education in phase two, a second retrospective chart review was conducted. The primary endpoint was the percentage of administered medications that were adherent to the algorithm. Secondary endpoints included percentage of medications considered first-line and second-line agents, and percentage of patient encounters that required a repeat agitation alert.
Results: A total of 88 agitation alerts from phase one and 30 from phase two were included in this study. The percentage of medications administered that were adherent to the institution’s guideline was 85.2% (109/128) in phase one and 89.5% (34/38) in phase two. In phase one, 63.3% (69/109) of these adherent medications were considered first line recommended agents, and 61.8% (21/34) in phase two. Of the medications that were adherent to the algorithm, 36.7% (40/109) were considered second line recommended agents in phase one, and 38.2% (13/34) in phase two. The percentage of repeat agitation alerts that met inclusion criteria per patient encounter in phase one was 20.5% (18/88) and 3.3% (1/30) in phase two.
Conclusion: Provider education did not affect the percentage of medications administered adherent to the algorithm or on medications considered first or second line. The percentage of repeat agitation alerts decreased following provider education. The findings are limited by minimal direct pharmacist input on medication selection. Future studies may explore the impact that pharmacists can make by providing real-time interventions during agitation alerts.