Enhancing Behavior Management in Inpatient Rehabilitation: A Provider-Focused Quality Improvement Initiative

Background and/or Objectives:

Background: Patients recovering from brain injury are at risk of displaying agitated behavior (i.e., restlessness, impulsivity, pulling at restraints, aggressiveness, or treatment refusal). During inpatient rehabilitation, managing agitation is vital, as it increases patient participation in therapies and promotes a culture of safety for staff and patients. Knowledge and skills of staff within an inpatient unit are required to manage agitation.

Objective: To increase rehabilitation providers’ (RP) behavior management knowledge and skills.

Design: Pre-Post Study

Setting : Inpatient Rehabilitation Hospital

Participants : 12 hospital staff members, including registered nurses (RNs) and certified nursing assistants (CNAs).

Interventions: Hospital staff participated in a newly developed Electronic-Learning (EL) Module, followed by an in-person Skills-Training (ST) within one month. The EL Module provided content knowledge to provide an understanding of agitation and interventions to address each level of agitation. The ST was led by a multidisciplinary team [MD, PhD, Registered Nurse (RN), Physical Therapist (PT), Occupational Therapist (OT), Speech-Language Pathologist (SLP)] and included simulations of agitation management and de-escalation techniques, review of hospital protocols, and training in the use of pelvic restraints.

Main Outcome Measures: A 9-item pre- and post-test related to the EL and ST training modules was developed and administered online to assess agitation/behavior management content knowledge.

Results: The average pre-test score among RNs and CNAs was 6.75 (SD = 1.138), and the average post-test score after EL and ST interventions was 7 (SD = 1.477). A paired t-test indicated no statistical significance between pre- and post-test scores (t=0.667, p>0.05).

Conclusions: Pre- and post-test score changes were statistically insignificant, but EL and ST interventions led to a trend of increased knowledge in a small sample size. These findings suggest that educational interventions for agitation management may have modest benefits but require refinement. Future plans include assessing the reliability of the pre- and post-test evaluations using a data set inclusive of other disciplines.