Australian Rotary Health

Esther Chan holds a Master of Clinical Pharmacy (MClinPharm) degree from Monash University. Prior to the commencement of her PhD in 2008, she worked as a clinical pharmacist in a wide range of clinical specialities within Austin Health, and was involved in research in the Emergency Department. At the completion of the MClinPharm, Esther was awarded the academic prize by Monash University.
 

Esther is currently an Honorary Research Fellow of the Austin Health Emergency Department and a PhD candidate of Monash University. The focus of her PhD is to improve the management of acute agitation in Emergency Department (ED). The literature suggests a clear need for the generation of best-practice evidence for chemical sedation in the ED. Esther’s PhD comprises a multi-centre clinical trial across three Victorian EDs. Her project is co-supervised by A/Prof David Taylor from Austin Health and Dr David Kong from Monash University. She hopes that the outcomes of her work will fill current knowledge gaps in the management of acute agitation, and will guide the delivery of safe, efficacious and cost-effective management of acute agitation in EDs globally.
 

Apart from clinical research in the Emergency area, Esther has an interest in medication use and safety, and the cost effective use of medicines in hospitals. Later this year, Esther will visit the ED of University Medical Centre, Tucson, Arizona, USA to exchange ideas regarding clinical pharmacy practice and research. This visit is supported by the 2009 DBL Young Pharmacist Award from The Society of Hospital Pharmacists of Australia.

SUMMARY OF PROJECT:

Acute agitation may be seen in many illnesses presenting to an Emergency Department, including schizophrenia, bipolar disorder, dementia, drug intoxication and mixed diagnoses. Chemical restraint is used when a patient is at risk of harming himself or others.

Symptoms of acute agitation include restlessness, excessive responses to stimulus and inappropriate verbal or physical activity. If not managed promptly agitation may progress to aggression and violence, posing a risk to the safety of the individual and others. In the Emergency Department, the goal of managing acutely agitated patients is the safe and rapid control of symptoms while the underlying illness is being investigated.
 

Traditionally, two main types of medications are used to calm acutely agitated patients in Emergency Departments: benzodiazepines (midazolam) and antipsychotics (droperidol). Newer antipsychotic medications (olanzapine) are of interest because of fewer side effects on patients’ airways. Droperidol and olanzapine may be given with a benzodiazepine. When given in combination these medications are thought to calm patients faster, require fewer doses of benzodiazepine, and hence fewer side effects.  However, there is no evidence to support this. 
 

Esther Chan’s research aims to improve the management of acute agitation in Emergency Department settings by:
 

   • Determining if the administration of droperidol or olanzapine together with midazolam results in
     faster sedation of the acutely agitated patient in the Emergency Department compared with
     midazolam alone
   • Exploring the safety of intravenous olanzapine administration
   • Determining the cost-effectiveness of using droperidol or olanzapine in combination with    
     midazolam in the management of acute agitation

The results of this study will fill a significant knowledge gap in the management of acute agitation in the Emergency Department. This study will provide the evidence to guide the delivery of safe, cost-effective and timely management of acute agitation on a local and nationwide level.