3.60 HALDOL AND ATIVAN INTRAMUSCULAR INJECTION ADMINISTRATION TRENDS FOR BEHAVIORAL EMERGENCY SITUATIONS IN AN ACUTE CARE REHABILITATION FACILITY FOR ADOLESCENTS

Objectives: Acute agitation in the form of aggression or self-harm is a serious obstacle in the treatment for adolescents in acute care rehabilitation facilities. Interventions such as restraints, seclusions, and intramuscular injections are aimed to be minimally used as they do not treat the underlying condition or illness and are viewed as last resort options when there are significant safety concerns for the patient, other youths, and staff members. This study investigates the use of intramuscular (IM) injections of combined haloperidol and lorazepam to identify possible variables in a patient's legal and medical record that may correlate with an increased risk of receiving multiple IM injections during treatment. Methods: A retrospective chart review of 63 patients (age 13-17 years) was conducted at an adolescent rehabilitation facility in Michigan from May 2011 to May 2013. The patients collectively received a total of 202 IM injections. Data analysis aimed to investigate whether any variables (DSM-IV axis I-IV disorder, juvenile record, prior hospitalizations, and other social history variables) correlated with the numbers of IM injections during care. Statistical analysis used negative binomial regression to calculate incident rate ratios (IRR) or how much more likely a subject was to receive an injection when a certain variable was present. Results: Increased numbers of IM injections were associated significantly with a diagnosis of schizophrenia (IRR: 4.04; P = 0.002), a diagnosis of a BD (IRR: 1.65; P = 0.026), prior IM injection (IRR: 3.66; P ≤ 0.001), substance abuse (IRR: 2.48; P ≤ 0.001), and having a juvenile record (IRR: 2.11; P = 0.001). Conclusions: Our study indicates several, easy to document clinical features that may predict which patients are at significantly higher risks for multiple future IM injections during their acute psychiatric and rehabilitation management. Such information may help focus the use of early therapeutic interventions aimed at reducing the number of IM injections an adolescent will receive.