NUBE 2024

Background:
Psychiatric patients presenting to the Behavioral Health Emergency Department can arrive in crisis with multiple co-occurring issues, including chronic or acute pain. Pain can cause or worsen anxiety and depression and is associated with increased disability and poorer quality of life in people with severe and persistent mental illness. Traditional pain management often relies on medication and poses risks and limitations in psychiatric care. Given the increased suicide risk associated with severe mental illness and pain, alternative non-pharmacologic approaches are imperative. Acupuncture and acupressure have been used for centuries to manage various disorders including pain.

The BH-ED supports patients during their most vulnerable time and often present in crisis. Patients come from diverse ethnic and socioeconomic backgrounds. Many patients have limited resources and utilize the ED as a place to receive treatment for their psychiatric and medical concerns.

Objective:
Assess the feasibility of nurses administering battlefield auricular acupressure (BAApress), patients' acceptance, and impact on pain and anxiety management.

Method:
Prior to initiating the study, nurses participated in the BAApress training done by BAApress Intervention initiated by AH WFBH Center for Nursing Research. Three Emergency Department nurses and study personnel received comprehensive BAApress training. The protocol consists of placing adhesive acupressure pads bilaterally on five specific auricular sites: 1) Cyngulate gyrus, 2) Thalamus, 3) Omega 2 4) Point Zero, and 5) Shen Men. These sites were selected based on the Veterans Administration Battlefield Auricular Acupressure Protocol for acute and chronic pain. This training process took approximately four hours. In this study, ten patients had five acupressure pads per ear placed at pre-selected acupoints as per battlefield auricular acupressure protocol shortly after admission and remained on patients during their stay. Patients were assessed daily for pain using Visual Analogue Scale Pain Scores and anxiety utilizing General Anxiety Disoder-7 on days 1 and 3.

Results:
Nurses were able to incorporate BAApress treatment without disruption to the nurse’s workflow. Results show 77% acceptance rate of acupressure treatment. Pain scores decreased each day (p=0.14). Anxiety scores significantly decreased (p=0.01). Nurses successfully initiated treatment in 77% of cases, with 100% patient satisfaction with pain management.

Conclusion:
Results showed substantial improvement in anxiety and modest improvement in pain, suggesting the potential for this treatment to be part of pain and anxiety management. Despite staffing challenges, nurses demonstrated ease in implementing this treatment effectively, suggesting its potential in various medical settings potentially benefiting a large group of patients. However, comprehensive large-scale studies are necessary to validate the effectiveness of battlefield auricular acupressure as an adjunct treatment in pain and anxiety management across diverse patient populations and settings.

Learning Objectives:

Determine feasibility of nurses administering BAA.

Assess effectiveness of battlefield auricular acupressure (BAA), as an adjunctive treatment for pain and anxiety.

Determine patients’ acceptance of this treatment modality.

Background: There have been significant increases in both pediatric visits for mental health to the emergency department, and the prevalence of autism spectrum disorder (ASD). However, there is a relative dearth of information about patients with autism spectrum disorder (ASD) or intellectual disability (ID) who seek emergency psychiatric care. There are unique challenges associated with this patient population in the emergency setting. Given this backdrop, this retrospective study explored clinical, demographic, and disposition-related information about this patient population over a 10-year period.

Methods: This study included individuals with ASD or ID (n =1461) and had presented to a psychiatric emergency department between 2012-2021. Data were extracted using a structured chart review methodology, and included demographic, clinical and visit information. Demographic data included: race/ethnicity, age, and primary insurance type. Clinical data included: Co-occurring disorders, reason for visit, prior treatment history, abuse history, and current medications. Visit data included: Medications given, restraints information, and disposition.

Results: Sample was predominantly White (77.21%), adolescent (mean age ± SD = 15.5 ± 4.3) and male (72.76%). There was an abuse history in a significant % of the sample, with physical abuse (16.97%) being the most prevalent. Psychiatric comorbidities were highly prevalent (84.47%). The most common reasons for presentation were aggression towards others (36.39%), suicidal ideation (22.56%), and self-injurious behaviors (11.16%). During the visit, 23.27% individuals received a new psychotropic medication, and physical restraint was utilized in 8.56% of visits. 28.27% of patients were psychiatrically hospitalized but 30% of those who needed hospitalization were discharged due to lack of inpatient bed availability. Presence of intellectual impairment (OR 1.97) and aggression (OR 3.57) were associated with a greater likelihood of discharge home due to inability to secure an inpatient bed.

Conclusion: This study adds to the limited literature about individuals with ASD or ID seeking emergency care. The results indicate a highly acute patient population with aggression, suicidal thoughts, and self-injurious behaviors who are frequently prescribed psychotropic medications and face barriers to accessing higher levels of care.

Learning Objectives:

Provide background information about the ASD/ID patient population in the emergency setting.

Explain the methods and results of this 10-year retrospective study.

Examine take home points about this study and what it says about optimal care for these patients and future research.