The multidisciplinary team perspectives on agitation management in critical care: A qualitative study

BACKGROUND People who are experiencing a period of critical illness frequently experience severe agitation. The presence of agitation can pose risks to the patient, family, and clinical team. AIMS AND OBJECTIVES To capture the views and opinions of critical care multidisciplinary teams concerning the approaches in the management of agitation, and to understand and identify the perceived risks and benefits of current management strategies. DESIGN A descriptive qualitative design. METHODS Data were gathered using semi-structured interviews with multidisciplinary teams from adult critical care units from one region in the United Kingdom. FINDINGS A total of 19 participants participated between February to September 2017. There were two group interviews (GIs) (n = 12, GI 1 n = 8, GI 2 n = 4) and seven one-to-one interviews, across four hospital organisations with one participant working via an agency. The mean length (± SD) of each interview, one to one or group, was 58.86 minutes (5.81 minutes). Three major themes were generated about the complex clinical decision-making required to manage an agitated patient. These themes represented: the burden of care, continuity of clinical decision-making, and uncertainty and indecision experienced by participants. CONCLUSION Participants described caring for an agitated patient as challenging and stressful. Staff sought clarification on what level of restrictive practice is allowed. Feelings of anxiety and stress generated by the decisions made may have an impact on staff, particularly those who are more inexperienced, which in the longer term could lead to fatigue or moral distress. RELEVANCE TO CLINICAL PRACTICE The study has emphasised the challenges faced by multidisciplinary teams and how decision-making may impact on individuals within the team.