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Quality Improvement (Original Research)

Implementation of the Agitated Behavior Scale for Children with Acquired Brain Injuries in an Academic Pediatric Hospital

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Original Research Theater
Disclosure(s):
Cara Arpey, DO: No relevant disclosure to display
Jordan M. Wyrwa, DO: No financial relationships to disclose
Kilby Mann, MD: No financial relationships to disclose
Background and/or Objectives: Agitation occurs in up to 71% of patients with acquired brain injuries (ABI) in inpatient rehabilitation (IPR). Managing agitation in children with ABI is crucial for optimizing outcomes. Over-treating can cause sedation, and under-treating can cause injuries and delayed progress. Prior to this initiative, agitation was not quantified at our hospital, preventing standardization of treatment, nor was there formalized agitation training for nurses.

Objectives: 1) Increase nursing knowledge of agitation and ABS by an average of 30% from before to after education. 2) Increase nursing confidence with agitation and ABS by an average of one point on a Likert scale from before to after education. 3) Increase ABS documentation adherence from 0% to 75% within three months.

Design: Quality improvement

Setting : Academic, tertiary pediatric hospital (IPR and medical floors)

Participants : Nurses of patients with ABI; patients 5-18 years with ABI and agitation

Interventions: 1) Designed an electronic medical record order set and flowsheet for the ABS. 2) Created a pre- and post-test about agitation and ABS. 3) Wrote educational slide deck about agitation and ABS.

Main Outcome Measures: 1) Nursing knowledge of agitation and ABS. 2) Nursing confidence with agitation and ABS. 3) Nursing adherence to charting ABS once per shift.

Results: Eight nurses completed both pre- and post-tests. Knowledge scores improved by 46.4 ± 26.9% (p < 0.01). Agitation confidence improved by 0.63 ± 0.52 points (p=0.011). ABS confidence improved by 1.8 ± 1.0 points (p < 0.01). Documentation adherence improved from 0% to 96% (217/227 shifts) after implementation.

Conclusions: Following education on agitation and the ABS, nursing knowledge improved by 46%. ABS documentation improved from 0% to 96%. This project illustrates the effectiveness of training and feasibility of nurses documenting agitation using the ABS. Quantifying agitation in the pediatric ABI population will effectively guide care and future research.