Behavioral Health Issues Clinical Pathway — Emergency Department

Recognizing Agitation

Agitation

Excessive, aimless psychomotor activity typically in response to an emotional/psychological trigger.

Aggression

Impulsive or premeditated behavior directed with the intent to cause harm.

PRESS Quick Assessment

P	Past History	Medical and behavioral, meds, prior behavior safety alert
R	Reasons for Agitation	Understand why, identify triggers/interests
E	Environment	Safety and therapeutic
S	Social	Review caregiver supports, consents
S	Severity	Assessment and response

Signs and Symptoms for Assessing Agitation

Signs and Symptoms	Reasons for Agitation	Contributing Factors
Verbal Escalations Increased voice volume Use of expletives Threatening statements Refusal to cooperate Physical Behaviors Pacing, fidgeting, picking Crying, rocking, withdrawing Destructive or violent toward self, staff, environment	Reasons for Agitation Physical Psychiatric Environmental Historical/situational anxiety Behavioral History Past triggers for agitation Successful and unsuccessful de-escalation tools	Situational Change in care plan Transfer to other units/facilities Removing belongings Blood draws, IV placement, testing Limited coping skills, available supports Medical History Neurodevelopment history Behavioral diagnosis Previous behavioral escalations History of traumatic brain injury Substance use/withdraw Presenting Concerns Suicidal ideation Involuntary hospitalization Aggression/outbursts Social Issues Forensic child CPS involvement Foster/out-of-home placement Strained familial relationships

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Behavioral Health Issues Clinical Pathway — Emergency Department

Recognizing Agitation

Agitation

Aggression

PRESS Quick Assessment

Signs and Symptoms for Assessing Agitation

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Innovation and your child

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Behavioral Health Issues — Recognizing Agitation — Clinical Pathway: Emergency

Behavioral Health Issues Clinical Pathway — Emergency Department

Recognizing Agitation

Agitation

Aggression

PRESS Quick Assessment

Signs and Symptoms for Assessing Agitation