immediate management of challenging behaviour

Last reviewed 01/2018

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