Abstract
Background
Agitation is a common reason for psychiatric consultation in the general hospital. The CL psychiatrist is often tasked with teaching the medical team how to manage agitation.
Objective
The purpose of this scoping review is to explore what resources the CL psychiatrist has for educational tools on teaching about agitation management. Given the frequency with which CL psychiatrists help with on-the-ground management of agitation, we hypothesized that there would be a scarcity of educational resources to teach front-line providers how to manage agitation.
Methods
Following current PRISMA guidelines, a scoping review was conducted. The literature search focused on the electronic databases MEDLINE (PubMed), Embase (Embase.com), The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), PsycInfo (EbscoHost), CINAHL (EbscoHost), and Web of Science. Using Covidence software, after screening for titles and abstracts, full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, we created a predefined set of criteria according to which each article was analyzed. We then grouped the articles in the full text review according to which patient population a curriculum was designed for.
Results
The search yielded a total of 3250 articles. After removing duplicates and review procedures, we included 51 articles. Data extraction captured article type and details; educational program information (staff training, web modules, instructor led seminar); learner population; patient population; and setting. The curricula were further divided based off of their target patient population, specifically the acute psychiatric patient (n=10), the general medical patient (n=9), and the patient with a major neurocognitive disorder such as dementia or traumatic brain injury (TBI) (n=32) . Learner outcomes included staff comfort, confidence, skills, and knowledge. Patient outcomes included measurements of agitation or violence using validated scales, PRN medication use, and restraint use.
Conclusion
Despite there being numerous agitation curricula in existence, we found that a large majority of these educational programs were done for patients with Major Neurocognitive disorders in the long-term care setting. This review highlights the gap in education related to agitation management for both patients and providers in the general medical setting as less than 20% of total studies are focused on this population. The CL psychiatrist plays a critical role in assisting in agitation management in this setting, which often requires collaboration between technicians, nurses, and non-psychiatric providers. It calls into question whether the lack of educational programs makes implementation of management interventions more difficult and less effective even with the assistance of the CL psychiatrist.