Implementation of Activity and Music on Agitation Management in Hospitalized Adults on a Medical-Surgical Unit

Abstract

Introduction Agitation is characterized by extreme restlessness, tension, and irritability. Agitated behaviors pose a risk to patient safety. Nonpharmacologic intervention is regarded as a first-line intervention strategy for agitation. In collaboration with Castle Medical Center’s (CMC) medical-surgical Pūlama unit, an evidence-based quality improvement project was undertaken to address patient agitation utilizing nonpharmacologic strategies. Following the Iowa Model for Evidence-Based Practice (EBP) as a framework, two nonpharmacologic interventions – music and activity – were selected from a review of literature and implemented into patient care. The purpose of this EBP project was to use these interventions to reduce the severity of agitated behaviors and enhance the overall quality of care. Methods This project focused on two target populations: (1) Pūlama staff and (2) Pūlama agitated patients. Pūlama staff were trained to implement music and activity intervention. Following training, agitated patients were sampled as recipients of nonpharmacologic intervention. Methods to assess project outcomes include Pittsburg Agitation Scale (PAS) scores and CMC hospital records. PAS scores were obtained before and after implementation of intervention to determine if the addition of nonpharmacologic intervention reduced agitation severity. Additionally, CMC hospital records were evaluated to see if the addition of these interventions impacted (a) use of patient sitters and (b) use of “as needed” (PRN) medications for agitation. Results Over the course of 3 months, 100 episodes of agitation were addressed using music and activity and evaluated using the PAS. Analysis showed an average decrease in agitation severity for all behavioral groups scored by the PAS after intervention. Incidentally, during the intervention period, CMC hospital records showed patient sitter use increased. Also, during this period, there was a decrease in PRN lorazepam use and an increase in PRN haloperidol use for the indication of agitation. Discussion The results suggested that agitated patients benefit from interventions of music and activity. The variety of intervention strategies utilized by staff support the need to individualize interventions to the preferences of each patient. Suggestions for sustainment of the project include modifying activity supplies to ease use, enhancing security of supplies, and considering various agitation assessment tools.