PSHP 2026 Residency Conference

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. 

Purpose: 
Harm reduction minimizes negative outcomes associated with substance use. Fentanyl test strips are distributed as a strategy due to its presence in local supply. The primary goal is to assess impact of test strips on high-risk behaviors.
 
Methods:
Retrospective chart reviews were conducted using the Veterans Health Administration (VHA) Computerized Patient Record System (CPRS) to collect data on 129 veterans who received fentanyl test strips from behavioral health teams between 10/02/2024 to 09/08/2025. Veterans receiving outpatient care aged 18 and older with active opioid and/or stimulant use disorder were included in our review. Veterans with significant cognitive impairments or acute psychiatric instability that prevent informed consent were excluded. A prospective component was planned but will not be reported due to insufficient enrollment.  
 
Results:
Among veterans offered fentanyl test strips, the majority accepted, with only a small percentage declining. A subset of veterans accepted additional fentanyl test strip kits when re-offered.  Additionally, many veterans who accepted the fentanyl test strips already had naloxone on hand, or received it concurrently. 
 
Conclusion:
Fentanyl test strip acceptance, including repeated offer acceptances, suggest potential utilization and perceived benefits by veterans. However, further evaluation is warranted to determine whether use leads to reduction in high-risk behaviors. Additionally, ensuring naloxone access alongside fentanyl test strip distribution further supports harm-reduction efforts to protect veterans who are at risk for opioid overdose. 
 

Purpose: The primary objective was to compare administration times of intravenous push (IVP) compared to piggyback (IVPB) antibiotics in the emergency department (ED) in patients with sepsis and septic shock. 


Methods: This retrospective, single-center, IRB-exempt, chart review conducted at Jefferson Einstein Philadelphia Hospital (JEPH) included ED patients with sepsis or septic shock who received either IVP or IVPB ceftriaxone or daptomycin. Patients with sepsis were identified by ICD-10 code and sepsis alert, and septic shock patients had vasopressor requirements. Patients were excluded if transferred from outside hospital. To account for institution-wide process changes due to drug shortages, IVPB antibiotics were evaluated from January 1, 2024 to September 30, 2024, and IVP antibiotics were evaluated from November 1, 2024 to July 31, 2025.


Results: Patients assessed for eligibility included 76 patients in the IVP group and 51 patients in the IVPB group. No patients who were administered daptomycin met inclusion criteria. There was no difference in median time to administration between the two groups (IVPB 40.8 min vs IVP 39.2 min. p=0.99). In patients with sepsis, 34/46 patients (73.9%) and 51/72 patients (70.8%) in the IVPB and IVP group received antibiotics within 3 hours, respectively. In patients with septic shock, 1/5 patients (20%) and 2/4 patients (50%) in the IVPB and IVP group received doses within one hour, respectively. Similar rates of in-hospital mortality were seen in septic shock patients, and no patients experienced a type-1 hypersensitivity reaction.



Conclusion:  Results showed no difference in administration times between IVP and IVPB ceftriaxone. Post-intervention IVP times to administration in prior studies were comparable to pre-intervention IVPB times to administration at JEPH. Future research should aim to evaluate potential factors that may contribute to delays in time to administration of antibiotics in sepsis and septic shock.