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Jordan C. Haygood, PharmD, BCPP
AAPP Program Committee Member
Clinical Assistant Professor
University of South Carolina College of Pharmacy

The prevalence of agitation associated with psychiatric emergencies is estimated to be as high as 10%.1 In the U.S. alone, agitation in the emergency department setting is estimated to be a rate of 1.7 million episodes annually.2 Individuals experiencing agitation are at risk of becoming aggressive and violent, putting themselves, their families, and health care professionals at risk for harm.2 Agitation can lead to increased health care costs by increasing hospital length of stay and contributing to readmission.1,3-4 Several rating scales have been developed to standardize the assessment of agitation, with many of these conceptualizing agitation on a spectrum and characterizing the emotional and behavioral components most often associated with the clinical picture of agitation.5 A greater appreciation of non-pharmacologic management of agitation as well as advancement in pharmacologic modalities for agitation warrants ongoing discussion. Pharmacists are uniquely positioned to assess for agitation and navigate various non-pharmacologic and pharmacologic strategies to manage symptoms effectively and accurately.6 This AAPP 2023 session is designed to educate participants on the general management and assessment of acute agitation while also exploring new and emerging treatment options.

The learning objectives for this session are:

  • Recall agitation assessment rating scales and appropriate utilization in various clinical practice settings.
  • Describe newly approved and emerging treatment options for the management of acute agitation.
  • Apply nonpharmacologic and pharmacologic approaches to the management of acute agitation across various settings and patient populations.
  • Identify potential improvements to the current management of agitation, including considerations for treatment barriers such as medication shortages.

The Programming Committee is excited to host AAPP member and co-author of the AAPP Pharmacist Toolkit: Agitation and Aggression in Practice, Jennifer Dress, PharmD, BCPP to help navigate the assessment and management of agitation across health care settings.

Dr. Dress is a Psychiatric Clinical Pharmacist and Clinical Pharmacy Supervisor at the Wilkes-Barre Veteran’s Affairs Medical Center in Wilkes-Barre, Pennsylvania. She earned her Doctor of Pharmacy degree from Wilkes University School of Pharmacy in 2010. She completed a PGY1 Pharmacy Practice Residency at the Chillicothe VAMC in Chillicothe, Ohio, and a PGY2 Psychiatric Pharmacy Residency at the University of Maryland School of Pharmacy in Baltimore, Maryland.

She has been working for the Wilkes-Barre VAMC for the past 10 years in various health care settings throughout the hospital. She has provided direct patient care in acute inpatient psychiatry units, outpatient mental health clinics, substance use treatment programs, acute and critical care units, and skilled nursing care units. She has also provided staff education and precepted many students and residents throughout these various hospital settings.

Dr. Dress is heavily involved in the management and prevention of agitation and aggression. She has taken a leadership role on her facility’s Disruptive Behavior Committee and as the facility’s Prevention and Management of Disruptive Behavior Training Coordinator. She is an active member of AAPP and currently serves on the Government Affairs Committee.

References

  1. Cots F, Chiarello P, Pérez V, Gracia A, Becerra V. Hospital Costs Associated With Agitation in the Acute Care Setting. Psychiatr Serv. 2016 Jan;67(1):124-7. doi: 10.1176/appi.ps.201400508. Epub 2015 Aug 3. PMID: 26234333.
  2. Holloman GH Jr, Zeller SL. Overview of Project BETA: Best practices in Evaluation and Treatment of Agitation. West J Emerg Med. 2012 Feb;13(1):1-2. doi: 10.5811/westjem.2011.9.6865. PMID: 22461914; PMCID: PMC3298232.
  3. Rubio-Valera M, Luciano JV, Ortiz JM, Salvador-Carulla L, Gracia A, Serrano-Blanco A. Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence. BMC Psychiatry. 2015;15:35. https://doi.org/10.1186/s12888-015-0417-x.
  4. Serrano-Blanco A, Rubio-Valera M, Aznar-Lou I, Baladón Higuera L, Gibert K, Gracia Canales A, et al. In-patient costs of agitation and containment in a mental health catchment area. BMC Psychiatry. 2017;17(1):212–23. https://doi.org/10.1186/s12888-017-1373-4.
  5. Dickens GL, O'Shea LE, Christensen M. Structured assessments for imminent aggression in mental health and correctional settings: Systematic review and meta-analysis. Int J Nurs Stud. 2020 Apr;104:103526. doi: 10.1016/j.ijnurstu.2020.103526. Epub 2020 Jan 11. PMID: 32062051.
  6. Miller J, Haight R, Shuman M. AAPP Pharmacist Toolkit: Agitation and Aggression in Practice [Internet]. Lincoln, NE: American Association of Psychiatric Pharmacists, 2022. [revised 2022 Sep 27]. Available from https://aapp.org/guideline/agitation-aggression.
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