Immediate management of challenging behaviour

Immediate management of challenging behaviour

Challenging behaviour becomes significant when violence, aggression and extreme agitation in the patient causes safety concerns to the patient and others around him/her (1).

Health professionals should be able to identify, monitor and address factors which may trigger challenging behaviour. These may be environmental, physical health or psychosocial factors:

• overcrowding
• lack of privacy
• lack of activities
• inadequate staff attention
• poor communication between the patient and staff In people requiring immediate management, consider
• moving the patient to a safe, low stimulation environment
• de-escalation techniques and physical restrain methods (only if necessary) can be used to manage
• if drugs are used,
• aim should be to reduce agitation and aggression without sedating the patient
• avoid high doses or combination of drugs (especially in elderly or frail patients)
• consider oral medication before offering parenteral medication
• when parenteral treatment is used, intramuscular (IM) should be preferred over intravenous route
  • IM preparations used include - lorazepam, haloperidol or olanzapine
  • diazepam or chlorpromazine should not be used
  • a single agent should be used whenever possible, if rapid sedation is required a combination of IM haloperidol and IM lorazepam can be used
  • patient should be monitored till they are stable (1)

Reference:

• 1. National Collaborating center for mental health 2007: Dementia: A NICE-SCIE guideline on supporting people with dementia and their carers in health and social care