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Immediate management of challenging behaviour

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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:


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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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