Agitation is an acute behavioral emergency requiring immediate intervention. Traditional methods of treating agitated patients, ie, routine restraints and involuntary medication, have been replaced with a much greater emphasis on a noncoercive approach. Experienced practitioners have found that if such interventions are undertaken with genuine commitment, successful outcomes can occur far more often than previously thought possible. In the new paradigm, a 3-step approach is used. First, the patient is verbally engaged; then a collaborative relationship is established; and, finally, the patient is verbally de-escalated out of the agitated state. Verbal de-escalation is usually the key to engaging the patient and helping him become an active partner in his evaluation and treatment; although, we also recognize that in some cases nonverbal approaches, such as voluntary medication and environment planning, are also important. When working with an agitated patient, there are 4 main objectives: (1) ensure the safety of the patient, staff, and others in the area; (2) help the patient manage his emotions and distress and maintain or regain control of his behavior; (3) avoid the use of restraint when at all possible; and (4) avoid coercive interventions that escalate agitation. The authors detail the proper foundations for appropriate training for de-escalation and provide intervention guidelines, using the “10 domains of de-escalation.”

These guidelines address all aspects of training including objectives, recommended training sites, rotation length, clinical supervision, curriculum content and evaluation. The objectives emphasize acute assessment and intervention skills. The AAEP Education Committee hopes that by implementing these guidelines, training programs will enable residents to become competent and comfortable working in a psychiatric emergency service.

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Background and Objectives Prescription Drug Monitoring Programs (PDMP) detect high‐risk prescribing and patient behaviors. This study describes the characteristics associated with documented PDMP access when prescribing opioids. Methods Retrospective chart review of 695 opioid prescriptions written from inpatient and outpatient medical and psychiatric settings. Data were abstracted and analyzed to identify characteristics associated with documented PDMP access. Results One‐third of the charts had PDMP access documented within the week of opioid prescription; 12% showed PDMP consultation on the same day. Services varied greatly from 10.5% (inpatient medicine) to 57% (inpatient psychiatry) with regard to same‐day PDMP access (P < .0001). Patient characteristics associated with PDMP access include having acute pain, current mental health treatment, and current and past substance use disorders (all P < .05). Logistic regression modeling identified three variables associated with the odds of PDMP access (c‐statistic = 0.66): if the prescription originated from the inpatient medicine unit (odds ratio [OR] = 0.47, 95% confidence interval [CI] = 0.32, 0.68), or if the patient received a prescription for an opioid in the past 30 days (OR = 0.30, 95% CI = 0.10, 0.90) or had a urine toxicology screen in the past year (OR = 2.00, 95% CI = 1.40, 2.90). Discussion and Conclusions Utilization of the PDMP varied by specialty and setting. Scientific Significance This study is among the first to compare rates of PDMP access in a large sample by specialty and practice setting in a healthcare system with a policy requiring its access and appropriate documentation. With less than one‐third adherence to the policy, additional steps to increase consistent PDMP access are warranted. (Am J Addict 2021;00:00–00)

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Evaluating a patient or client who may be at imminent risk of lifethreatening behavior requires skills that go beyond those needed for the traditional clinical interview. With a patient or client who is in a volatile emotional state, the interview process often takes place in a charged atmosphere. The patient is stressed and the clinician may be stressed as well. The clinician needs to be concerned about dealing with and attempting to modulate the emotional state of an individual who may be hostile, agitated, paranoid, or impulsive. The patient or client may provide incomplete and conflicting information. There may be pressure to arrive at an assessment of the problem and a decision about management in a very limited period of time.There may be other workload demands to which the clinician feels that he or she needs to attend. If the patient begins to lose behaviotal control, the interviewer must be thinking about what he or she may need to do to ptevent the patient from harming him-or herself, or others. Decision making under such conditions can be compromised, and errors in judgment can occur that may have serious consequences for the patient, the clinician, and for others (Cannon-Bowers & Salas, 1998b).

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