Physical health monitoring after rapid tranquillisation: clinical practice in UK mental health services (original) (raw)
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Rapid tranquilization: An audit of Irish mental health nursing practice
International journal of mental health nursing, 2018
Rapid tranquillization is a pharmacological intervention sometimes employed in mental health care for the management of acute behavioural disturbance. It is a form of restrictive practice, which, along with seclusion and restraint, is a conventional and controversial intervention in the therapeutic management of risk in mental health settings. This study surveyed mental health nurses practice in rapid tranquillization. A self-report questionnaire was utilized which addressed aspects such as definitions of rapid tranquillization, presence of rapid tranquillization policy, types of incidents where it is used and postintervention monitoring. The results demonstrate that rapid tranquillization is an intervention used in the management of acute behavioural disturbance in various mental health settings in Ireland. Respondents showed a basic understanding of rapid tranquillization as an intervention; however, some areas reported not having a specific rapid tranquillization policy. There wa...
BMC Psychiatry, 2013
Background Acute behavioural disturbance (ABD) is a common problem in psychiatry and both physical restraint and involuntary parenteral sedation are often required to control patients. Although guidelines are available, clinical practice is often guided by experience and there is little agreement on which drugs should be first-line treatment for rapid tranquilisation. This study aimed to investigate sedation for ABD in an acute mental healthcare unit, including the effectiveness and safety of high dose sedation. Methods A prospective study of parenteral sedation for ABD in mental health patients was conducted from July 2010 to June 2011. Drug administration (type, dose, additional doses), time to sedation, vital signs and adverse effects were recorded. High dose parenteral sedation was defined as greater than the equivalent of 10 mg midazolam, droperidol or haloperidol (alone or in combination), compared to patients receiving 10 mg or less (normal dose). Effective sedation was defin...
Journal of psychopharmacology (Oxford, England), 2018
The British Association for Psychopharmacology and the National Association of Psychiatric Intensive Care and Low Secure Units developed this joint evidence-based consensus guideline for the clinical management of acute disturbance. It includes recommendations for clinical practice and an algorithm to guide treatment by healthcare professionals with various options outlined according to their route of administration and category of evidence. Fundamental overarching principles are included and highlight the importance of treating the underlying disorder. There is a focus on three key interventions: de-escalation, pharmacological interventions pre-rapid tranquillisation and rapid tranquillisation (intramuscular and intravenous). Most of the evidence reviewed relates to emergency psychiatric care or acute psychiatric adult inpatient care, although we also sought evidence relevant to other common clinical settings including the general acute hospital and forensic psychiatry. We conclude...
Use of psychotropic medication in seven English psychiatric intensive care units
The Psychiatrist, 2010
Psychiatric intensive care units (PICUs) are designed to treat in-patients who display seriously disturbed behaviour and who cannot be safely treated in an open acute psychiatric ward. 1 The units generally admit detained patients whose behaviour is judged to present a significant risk to others, 2,3 and sometimes use potentially risky interventions such as rapid intramuscular (IM) tranquillisation and high-dose medication in order to maintain a safe environment. 4 A number of protocols guide the management of seriously violent behaviour. The most widely used UK guidelines are probably those produced by the National Institute for Health and Clinical Excellence (NICE) and the Maudsley Hospital. 5,6 The high-risk nature of some PICU activity means that it is important that individual units have effective procedures for clinical governance and monitoring treatment. However, there is little published data on clinical activity in PICUs and minimal reference data against which units can measure their own activity. Surveys of PICU policies and practice leave doubts about whether answers to hypothetical questions reflect actual practice. 2,7 Prescribing patterns on individual PICUs 8-11 may not generalise to other units. The limited evidence suggests that the prescribing practices of different PICUs are converging 12 but it is difficult to judge the appropriateness of individual practices without reference data from representative units. This paper aims to provide such reference data by describing the drug treatments given to 332 patients consecutively admitted to seven English PICUs. ORIGINAL PAPERS Brown et al Psychotropic medication in psychiatric intensive care units
BMC psychiatry, 2002
Agitated or violent patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians and clinical practice all differ. Systematic reviews show that all relevant studies are small and none are likely to have adequate power to show true differences between treatments. Worldwide, current treatment is not based on evidence from randomised trials. In Brazil, the combination haloperidol-promethazine is frequently used, but no studies involving this mix exist. TREC-Rio (Tranquilização Rápida-Ensaio Clínico [Translation: Rapid Tranquillisation-Clinical Trial]) will compare midazolam with haloperidol-promethazine mix for treatment of agitated patients in emergency psychiatric rooms of Rio de Janeiro, Brazil. TREC-Rio is a randomised, controlled, pragmatic and open study. Primary measure of outcome is tranquillisation at 20 minutes but effects on other measures of morbidity will also be assessed. TREC-Rio will involve the collaborati...
Addiction, 1989
Data related to tranquilliser/hypnotic use is presented from a large (n=9,003) random representative United Kingdom sample of adults (18+ years). On the day of interview 4.2% of females and 2.1% of males reported current use of tranquillisers. Increased probability of current use was significantly related to female sex, older age, increased symptoms of psychological malaise and physical ill-health, elevated neurotidsm scores on the Eysenck Personality Inventory, lower socioeconomic status, unemployment, current smoking in some groups, and less participation in active leisure pursuits. There was no convincing trend with standard geographical region.
Journal of Psychiatric Intensive Care, 2008
Background: Rapid tranquillisation is used when control of agitation, aggression or excitement is required. Throughout the UK there is no consensus over the choice of drugs to be used as first line treatment. The NICE guideline on the management of violent behaviour involving psychiatric inpatients conducted a systematic examination of the literature relating to the effectiveness and safety of rapid tranquillisation (NICE, 2005). This paper presents the key findings from that review and key guideline recommendations generated, and discusses the implications for practice of more recent research and information. Aims: To examine the evidence on the efficacy and safety of medications used for rapid tranquillisation in inpatient psychiatric settings. Method: Systematic review of current guidelines and phase III randomised, controlled trials of medication used for rapid tranquillisation. Formal consensus methods were used to generate clinically relevant recommendations to support safe and effective prescribing of rapid tranquillisation in the development of a NICE guideline. Findings: There is a lack of high quality clinical trial evidence in the UK and therefore a 'gold standard' medication regime for rapid tranquillisation has not been established. Rapid tranquillisation and clinical practice: The NICE guideline produced 35 recommendations on rapid tranquillisation practice for the UK, with the primary aim of calming the service user to enable the use of psychosocial techniques. Conclusions and implications for clinical practice: Further UK specific research is urgently needed that provides the clinician with a hierarchy of options for the clinical practice of rapid tranquillisation.
Rapid tranquillisation of violent or agitated patients in a psychiatric emergency setting
British Journal of Psychiatry, 2004
BackgroundThe pharmacological management of violence in people with psychiatric disorders is under-researched.AimsTo compare interventions commonly used for controlling agitation or violence in people with serious psychiatric disorders.MethodWe randomised 200 people to receive intramuscular lorazepam (4 mg) or intramuscular haloperidol (10 mg) plus promethazine (25–50 mg mix).ResultsAt blinded assessments 4 h later (99.5% follow-up), equal numbers in both groups (96%) were tranquil or asleep. However, 76% given the haloperidol-promethazine mix were asleep compared with 45% of those allocated lorazepam (RR=2.29, 95% CI 1.59–3.39; NNT=3.2, 95% CI 2.3–5.4). The haloperidol-promethazine mix produced a faster onset of tranquillisation/sedation and more clinical improvement over the first 2 h. Neither intervention differed significantly in the need for additional intervention or physical restraints, numbers absconding, or adverse effects.ConclusionsBoth interventions are effective for con...
International journal of mental health nursing, 2020
Behavioural assessment units (BAU) have been established in emergency departments (EDs) to provide short-term observation, treatment, and care to people experiencing acute behavioural disturbance. A prospective observational study was conducted in a cohort of adult patients admitted to one BAU located within an ED (July-December 2017) to compare clinical characteristics, treatment outcomes, and use of restrictive interventions for those who received a specialist mental health (MH) assessment with those who did not. Of the 457 patients, 61.5% received a specialist MH assessment. This group had a lower acuity (Australasian Triage Score 10.4%; CI 0.2-2.0% vs 13.6%; CI 9.3-19.5%); more arrived with police (28.8%; CI 23.8-34.3 vs 5.1%; CI 2.7-9.4%); and were subjected to restrictive interventions while in the BAU. Security responses for unarmed threat (code grey) were higher (10.9%; CI 7.8-15.0% vs 4.4%; CI 2.3-8.5%), as was the use of chemical restraint (4.2%; CI 2.4-7.2 vs 0.0% CI 0.0 ...