Evaluating the impact of an emergency department protocol that guides management of methamphetamine-induced agitation and psychosis.
acute agitation
agitation
antipsychotics
benzodiazepines
emergency room
methamphetamine
methamphetamine induced agitation
methamphetamine psychosis
stabilization
substance use
Journal
The mental health clinician
ISSN: 2168-9709
Titre abrégé: Ment Health Clin
Pays: United States
ID NLM: 101728585
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
13
07
2021
accepted:
02
11
2021
entrez:
4
2
2022
pubmed:
5
2
2022
medline:
5
2
2022
Statut:
epublish
Résumé
Methamphetamine is an addictive stimulant that may induce symptoms of agitation and psychosis. The estimated rate of methamphetamine use is 6.6 per 1000 people. Currently, no treatment guidelines exist to support the optimal management of patients presenting with methamphetamine-induced agitation. Emergency department (ED) providers may prescribe various benzodiazepines (BZDs) and antipsychotics (APs) as first-line agents to stabilize these agitated patients. This study aims to determine the effectiveness of a protocol to guide management of this condition. This was a retrospective, pre- and poststudy conducted from July 2020 to March 2021 at a large academic medical center. A multidisciplinary protocol was designed to help manage methamphetamine-induced agitation in the ED. The primary outcome of the study was a reduction in the number of BZDs and APs used for the treatment of methamphetamine-induced agitation. This was measured by the incidence of overprescribing, defined as 3 or more APs or BZDs administered within 30 minutes. Secondary outcomes included the use of physical restraints, ED length of stay, and adverse events. We did not observe a significantly lower incidence of overprescribing, adverse events, or ED length of stay when comparing pre- and postprotocol groups. A subgroup analysis demonstrated that when protocol was followed, there was a statistically significant reduction in overprescribing ( We did not find any differences among our primary and secondary outcomes, which may be attributed to protocol nonadherence. Full compliance to the protocol may reduce the rate of overprescribing APs or BZDs in patients with methamphetamine-induced agitation.
Sections du résumé
BACKGROUND
BACKGROUND
Methamphetamine is an addictive stimulant that may induce symptoms of agitation and psychosis. The estimated rate of methamphetamine use is 6.6 per 1000 people. Currently, no treatment guidelines exist to support the optimal management of patients presenting with methamphetamine-induced agitation. Emergency department (ED) providers may prescribe various benzodiazepines (BZDs) and antipsychotics (APs) as first-line agents to stabilize these agitated patients. This study aims to determine the effectiveness of a protocol to guide management of this condition.
METHODS
METHODS
This was a retrospective, pre- and poststudy conducted from July 2020 to March 2021 at a large academic medical center. A multidisciplinary protocol was designed to help manage methamphetamine-induced agitation in the ED. The primary outcome of the study was a reduction in the number of BZDs and APs used for the treatment of methamphetamine-induced agitation. This was measured by the incidence of overprescribing, defined as 3 or more APs or BZDs administered within 30 minutes. Secondary outcomes included the use of physical restraints, ED length of stay, and adverse events.
RESULTS
RESULTS
We did not observe a significantly lower incidence of overprescribing, adverse events, or ED length of stay when comparing pre- and postprotocol groups. A subgroup analysis demonstrated that when protocol was followed, there was a statistically significant reduction in overprescribing (
DISCUSSION
CONCLUSIONS
We did not find any differences among our primary and secondary outcomes, which may be attributed to protocol nonadherence. Full compliance to the protocol may reduce the rate of overprescribing APs or BZDs in patients with methamphetamine-induced agitation.
Identifiants
pubmed: 35116207
doi: 10.9740/mhc.2022.01.009
pii: MHC-D-21-00044
pmc: PMC8788303
doi:
Types de publication
Journal Article
Langues
eng
Pagination
9-14Informations de copyright
© 2022 CPNP. The Mental Health Clinician is a publication of the College of Psychiatric and Neurologic Pharmacists.
Déclaration de conflit d'intérêts
Disclosures: The authors have no disclosures.
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