Table 3.

Barriers and Facilitators to Pediatric Acute Agitation Care

Theme	Exemplar Physician and Nurse Quotes	Exemplar Parent and Adolescent Quotes
Using a standardized care pathway	“There’s a very clear pathway of first line, second line medications that I think really helps control the situation much faster.” (Nurse) “Sometimes I use the workflow to push the point to physicians… this is what we should be doing.” (Nurse)	“It’s like trying to put out a small fire before it turns a huge one.” (Parent)
Identifying environmental barriers and allocating resources	“It is not unusual when a patient has hit the severe agitation point that it requires four to seven humans and that’s a combination of nursing, physicians, residents, security.” (Physician) “If you have a couple other really sick kids it’s hard to be as available as you want to be for agitated patients.” (Nurse)	“We tried to dim the lights, make it less stimulating, make it more calming for him but we can only do so much when he doesn’t like his environment.” (Parent) “Based on something they saw on their computer or whatnot, it made them decide my issue wasn’t important as the other issues. It was 50 minutes less important… Even if it’s an issue that’s less severe doesn’t mean it’s not still bothering that person.” (Adolescent)
Partnering with the family and child	“The family and the patient are part of this decision making… Giving them as much control in management as possible back to them is important.” (Nurse) “Manage expectations, see what immediate needs there are, answer questions. All of that front end work is gonna pay off because then you’re gonna have this cool, calm, cooperative kid that for the rest of the night is gonna be chill, ya know?” (Nurse)	“If the child is not calm and is crying, they probably wouldn’t want to talk, so they should ask the parents if they need anything… I know the parent knows what the child needs.” (Adolescent) “They treated me with respect. Like they care about you and they want you to feel better and they want to do everything they can.” (Adolescent)
Communicating among team members	“I feel like it is pivotal and really important that the bedside nurse is involved and is listened to, because that person probably has been… involved in that child’s care prior to that and should be part of the decision-making process.” (Nurse) “Most everything is just done through the EMR [electronic medical record], which is sad that we’ve lost the ability to communicate with each other, but it’s something that’s happened with computers.” (Nurse)	“There’s nothing like dealing with an already agitated child and then having different providers ask the same set of questions over and over again.” (Parent)