NPI at the Bedside

Control Positive and Negative Stimulation

Maximize positive stimulation

  • Redirection, reorientation
    • 1:1 observation/sitters/companions
  • Provide visual and hearing aids when available
    • Pocket talkers (hearing amplifier), glasses, magnifying glasses, large print consent forms
  • Orientation cues
    • Calendars, clocks
  • Monitor nutrition and hydration
  • Mobilize; out of bed to chair
  • Promote family and caregiver visits
  • Control pain
  • Allow for uninterrupted sleep
  • Ensure dentures

Minimize negative stimulation

  • Minimize environmental stimulation
  • Minimize sensory impediments
  • Avoid indwelling catheters, IV lines
  • Review medications
    • Avoid inappropriate medications: Anticholinergics, Antihistamines, Benzodiazepines
  • Avoid restraint use
    • Increases risk of falls, injury, and delirium
    • Use only in an emergency for as short a duration as possible with frequent re-evaluations
    • Foley; oxygen; telemetry monitors; bed alarm; side rails: discontinue ASAP
  • Monitor bowel and bladder functioning and fluid-electrolyte balance

De-escalation Techniques for Agitated Behaviors


  • Respect personal space
  • Do not be provocative
  • Establish verbal contact
  • Be concise and use simple language (e.g., single-step instructions/statements)
  • Listen closely to what the patient is saying
  • Set clear limits
  • Debrief the patient and staff


De-escalation techniques for agitation behavior e.g. ADEPT tool


Martinez FT, et al. Age Ageing. 2012;41(5):629–634.

Richmond JS, Berlin J, Fishkind A, et al. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. West J Emerg Med. 2012;13(1):17-25.


ASAP, as soon as possible

IV, intravenous

NPI, nonpharmacologic intervention