Patient Behaviour
|
Mild Agitation
- BOC-score 0
- Anxious and agitated. But able to be redirected and reassured
|
Escalating Behaviour
- BOC-score 1-2
- Becoming more distressed and agitated with possible risk of unintended aggression
|
Behavioural Crisis
- BOC-score >2
- Severe agitation and distress posing risk to patient and staff safety
|
Behavioural Emergency
- BOC-score >2
- Persisting aggressive behaviour despite sedation
|
Immediate Considerations
|
Prefer non pharmacological strategies |
Maximise non pharmacological strategies
Consider BAR/BOCR
Low stimulus environment |
Code grey – Security present
Least restrictive practice
Consider BAR/BOCR if appropriate |
Continued security presence
Move to monitored area
ED consultant/senior registrar involvement |
Medications
|
Choose one of:
Haloperidol (if no history of Parkinsonism) PO
0.25-0.5mg PO
repeat after 2 hours (max of 3mg/24hours)
OR
Quetiapine (preferred in Parkinsonism) PO
12.5-25 mg PO
Repeat after 2 hours (max 100 mg/24 hours)
OR
Olanzapine PO
2.5mg PO – repeat after 2 hours (max 5 mg /24 hours)
OR
Risperidone (if already on it from RCF) PO
0.5 mg PO – repeat after 2 hours (max 2 mg/24 hours) |
Choose one of:
Haloperidol (if no history of Parkinsons) IM/IV
0.5-1mg IM – repeat after 1 hour (max of 3mg/24 hours)
OR
0.5-1mg IV – repeat after 30 minutes
(max 3 mg/24 hours)
OR
Midazolam – IM/IV – Single dose only
1-2mg IM (max 2 mg/24 hours)
0.5-1mg IV – repeat after 15-30 minutes
(max 2mg/24hours)
OR
Olanzapine – IM – Single dose only
2.5-5mg IM (max 5 mg/24 hours) |