Pre-post implementation study of a medication-focused order set for management of acute agitation in a pediatric emergency department

Prescribing practices, including medication selection, ordered frequency, ADC overrides, and combination therapy, differed following the implementation of a medication-focused order set for acute agitation. Transitioning to empiric oral and intramuscular olanzapine as first-line therapy, diphenhydramine as second-line therapy, and olanzapine as third-line therapy did not increase the rate of medication administration or utilization of subsequent lines of therapy. Additional studies are needed to better understand individualized response, adverse effects, and the incidence of oversedation with pharmacotherapy for acute agitation management in pediatric patients in the ED setting.