Recommendations for non-pharmacological management of patient agitation in the adult ICU

Patient agitation is a common phenomenon in the intensive care unit (ICU). The behaviours are distressing and can be dangerous for patients, staff and clinicians. While drugs play an essential role in keeping patients safe and treating underlying causes of agitation, they can have serious side effects. Therefore, clinicians are encouraged to use non-pharmacological strategies when possible. Yet, there are no guidelines for non-pharmacological management of agitation.

Objective: This study aimed to develop preliminary patient-centred clinical practice guidelines for non-pharmacological prevention, minimisation and management of patient agitation in Danish and Australian adult ICUs

Methods: This study was undertaken in three phases, supported by a unique conceptual framework, NHMRCs guidelines for guideline development, and a mixed methods design. The first phase consulted Danish and Australian stakeholders to determine the scope of the guidelines. The second phase systematically reviewed the existing evidence. The last phase identified non-pharmacological strategies for agitation in a three-round modified Delphi study.

Results: Stakeholder consultation in the first phase resulted in major changes to the scope of the guidelines. Two systematic reviews in the second phase found limited evidence of non-pharmacological strategies for agitation. The Delphi study, involving 114 Danish and Australian ICU clinicians, researchers, previous patients and their family members, identified 63 recommendations, forming a new model of care for agitated patients. Participants from the two countries were unable to agree about a number of non-pharmacological strategies, some related to physical restraints and continuity of care.

Conclusion: This study demonstrated that developing guidelines across countries has many advantages. It is clear that providing fundamental care is essential when aiming to reduce patient agitation in the ICU. However, how staff deal with agitation is likely to reflect the broader organisational culture and the values the organisation places on non-pharmacological strategies.

Acknowledgement: This study was supported by a seeding grant from the Australian College of Critical Care Nurses (ACCCN). The primary investigator is a recipient of an Australian Government Research Training Program Scholarship and is a Flinders University-Aalborg University Inaugural Erik Elgaard Sørensen Scholar.