Chemical patient restraint: A systematic review

Background: The use of drugs to sedate patients including older adults is one example of off-label prescribing for licensed therapeutics. The practice may be common in long-term care, emergency departments, and mental health facilities. Drugs are used instead of (or in combination with) physical restraint to respond to agitation. This project sought to examine the scientific literature for evidence of prevalence and of patient safety. Methods: qualitative systematic review. Four MeSH search terms were used in the PubMed index: Psychomotor agitation/drug therapy, Chemical restraint, Covert medications, and Hypnotics and sedatives/administration and dosage. This initially yielded 170 articles. We excluded articles not relevant and coded 122 articles. After modifying the codes for emergent themes, we analyzed 101 relevant articles. Results: The review yielded mostly reports of drug efficacy studies (96/101, 95%). About 29% of the drug efficacy studies (28/96) included a mention of adverse events in the abstract. About 15% of the articles reviewed focused on restraint for older adults, and 6% focused on children. Many of the studies were testing drugs for restraint for patients with diagnosed mental illness, and 31% of those studies (18/59) included schizophrenic patients. About 16% of the articles were testing drugs in emergency rooms, and only 4% were in long-term care settings. Conclusion: The literature does not provide much evidence about safety. Appropriate next steps in this study might include: coding for the class of drug being researched (e.g. atypical antipsychotics, etc), and reviewing the full text articles for discussions of safety and risk management.