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Halifax Health offers new care for brain injury patients

News-Journal - 5/26/2019

DAYTONA BEACH 2019--DAYTONA BEACH -- A Halifax Health study aimed at lowering agitation in patients with traumatic brain injuries has been published in an international journal geared at helping those who care for critically ill patients.

Dr. Eugene Rankin, a clinical neuropsychologist and researcher for the Halifax Health Level II Trauma Center and the Brooks Rehabilitation Center for Inpatient Rehabilitation, was the lead author of the study, which appeared in the Journal of the Intensive Care Society, a publication based in the United Kingdom. Four other Halifax Health employees co-authored the piece which detailed a method that led to a significant reduction in agitation in patients with traumatic brain injuries.

"We needed to have something better to deal with traumatic brain injury patients who were agitated," Rankin said. "There are limited guidelines on what to do with agitated patients as they go along (in their recovery)."

Agitation following a severe traumatic brain injury is a frequent component of recovery, often characterized by restlessness, impulsiveness, excessive movement and repetitive behaviors.

Many symptoms associated with a traumatic brain injury can lead to agitation, including loss of consciousness, confusion, problems with speech, difficulty sleeping, dizziness, sensory issues like blurred vision, ringing in the ears, changes in ability to smell, sensitivity to light or sound, memory and concentration issues, mood swings, depression, seizures, numbness in extremities and changes in the ability to concentrate.

"Many people are scared when they are agitated," Rankin said. "We've had staff and family members injured by people with traumatic brain injury agitation. It's dangerous to the patient as well and they may (need to) be restrained."

Rankin saw the challenges the trauma and rehabilitation departments at the hospital were facing firsthand and in 2017 devised a method to help patients and those caring for them safely move through recovery.

"First we needed to know how to measure agitation," Rankin said. "We came up with a 14-item scale and rate individual items between one and four on whether (the patients') symptoms are extreme, present or not present at all."

Items rated included attention span, concentration and tolerance level. Nurses measured the patients every 12 hours and logged the results.

"We measure their agitation and treat them accordingly with drugs and environment changes," Rankin said. "This can simply be limiting the number of people in the room or changing the lighting."

Anti-seizure and anti-psychotic medications were used in the study to calm the patients.

"We have to be judicious about using these medications," Rankin said. "We want patients to be calm but not overly sedated."

In the study, the average length of stay in the trauma center for patients with agitation associated with a traumatic brain injury was 20.6 days. For those patients who were not agitated the length of stay was 15.4 days, according to Rankin.

The study was conducted between January and June 2018, with 30 patients at the Halifax Health trauma center. According to Rankin, agitation in these patients was treated successfully and most importantly, the average length of stay was significantly reduced.

"We have enhanced patient safety, family safety, staff safety and have exposed ourselves as an expert in this area of care," Rankin said. "It's a great feeling to have this (study) published."

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