Behavioral Activity Rating Scale (BARS)

• BARS can be reassessed at multiple time points after an intervention for agitation.

• Given its ease of use and strong inter-rater reliability, any clinical team member at the bedside with the patient can report a BARS score.

BARS is a seven-point scale with scores ranging from 1 to 7. Scores are assigned based on a single clinical observation. 

• BARS 1-3: Additional medical workup may be needed.
• BARS 4: Likely normal behavioral activity, intervention not needed.
• BARS 5-6: Indicate the need for verbal de-escalation or other behavioral interventions.
• BARS 7: Patient likely to require pharmacologic intervention and/or physical restraints. May require additional medical workup. 

• Attempt verbal de-escalation with patients with BARS 5-6 before resorting to chemical or physical restraints. 

• Broaden the differential diagnosis to include possible medical causes of sedation or agitation in patients with BARS 1-3 or 7.

• Patients with BARS 1 require close monitoring regardless of the etiology of their behavioral state.