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Pattern of rapid tranquillisation and restraint use in a central London mental health service

Published online by Cambridge University Press:  31 July 2014

Neil Shepherd ,
Caroline Parker  and
Nawal Arif
Neil Shepherd*
Affiliation:
Central and North West London NHS Foundation Trust
Caroline Parker
Affiliation:
Central and North West London NHS Foundation Trust
Nawal Arif
Affiliation:
Central and North West London NHS Foundation Trust
*
Correspondence to: Neil Shepherd, Specialist Pharmacist, St Charles Hospital, Exmoor Street, London W10 6DZ. E-mail: [email protected]
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Abstract

Rapid tranquillisation (RT) aims to quickly calm the severely agitated patient, in order to reduce the risk of imminent and serious violence to self or others. While it is widely used within mental health care settings, there is little published information on patterns of practice. Retrospective data collection identified a total of 2267 incidents of RT within the Central and North West London NHS Foundation Trust over a 19 month period equating to a mean frequency of approximately four incidents per day. These incidents mainly occurred in acute inpatient services and two and a half times more frequently in PICUs than on open wards. Of all the PICUS, the female PICU used most RT. Intramuscular RT was reported more often in most services. Restraint was used in 57% (n=1300) of RT incidents and minor injury resulted in only 11% of these incidents overall. There were no reports of major injury or death in the data set. Variations in RT use were seen across the Trust’s geography and ward types.

Keywords

Rapid tranquillisationrestraintmedicine
Type
Original Research Articles
Information
Journal of Psychiatric Intensive Care , Volume 11 , Issue 2 , August 2015 , pp. 78 - 83
Copyright
© NAPICU 2014 

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References

Aiken, F., Duxbury, J., Dale, C. and Harbison, I. (2011) Review of the medical theories and research relating to restraint related deaths. Caring Solutions (UK), University of Central Lancashire, 94 pp.Google Scholar
Akram, G., Slavin, A. and Davies, P. (2014a) The administration of psychotropic PRN medication in Scottish psychiatric intensive care units. Journal of Psychiatric Intensive Care. 10(2): 64–74. doi: 10.1017/S1742646414000028 Google Scholar
Akram, G., Slavin, A. and Davies, P. (2014b) Characterising the nature of psychotropic medication prescribed in Scottish PICUs. Journal of Psychiatric Intensive Care. 10(2): 75–83. doi: 10.1017/S1742646414000016 Google Scholar
Baker, J., Lovell, K. and Harris, N. (2008) A best-evidence synthesis review of the administration of psychotropic pro re nata (PRN) medication in in-patient mental health settings. Journal of Clinical Nursing. 17: 1122–1131.Google Scholar
Banerjee, S., Bingley, W. and Murphy, E. (1995) Deaths of detained patients: a review of report to the Mental Health Act Commission. Mental Health Foundation, 32 pp.Google Scholar
Brown, S., Chhina, N. and Dye, S. (2010) Use of psychotropic medication in seven English psychiatric intensive care units. The Psychiatrist. 34: 130–135. doi: 10.1192/pb.bp.108.023762 CrossRefGoogle Scholar
Choudhury, R., Dewsbery, M., Williams, K. and Hovey, N. (2011) Audit of the rapid tranquilization policy in the 2gether NHS Foundation Trust. Journal of Psychiatric Intensive Care. 7(1): 55–61. doi: 10.1017/S1742646410000142 Google Scholar
Curtis, J. and Capp, K. (2003) Administration of ‘as needed’ psychotropic medication: a retrospective study. International Journal of Mental Health Nursing. 12: 229–234.Google Scholar
Innes, J. and Curtis, D. (2013) Medication patient safety incidents linked to rapid tranquillisation: one year’s data from the National Reporting and Learning System. Journal of Psychiatric Intensive Care. Published online 11 October 2013, doi: 10.1017/S1742646413000277 Google Scholar
Innes, J. and Iyeke, L. (2012) A review of the practice and position of monitoring in today’s rapid tranquilisation protocols. Journal of Psychiatric Intensive Care. 8(1): 15–24. doi: 10.1017/S1742646411000057 Google Scholar
Loynes, B., Innes, J. and Dye, S. (2012) Assessment of physical monitoring following rapid tranquillisation: a national survey. Journal of Psychiatric Intensive Care. 9(2): 85–90. doi: 10.1017/S1742646412000295 Google Scholar
MIND (2013) Mental health crisis care: physical restraint in crisis. A report on physical restraint in hospital settings in England. 32 pp. http://www.mind.org.uk/media/197120/physical_restraint_final_web_version.pdf Google Scholar
National Institute for Health and Clinical Excellence (2005) Violence: The short term management of disturbed and violent behaviour in inpatient psychiatric settings and emergency departments. NICE, CG25. http://www.nice.org.uk/guidance/CG25 Google Scholar
O’Brien, A., Cramer, B., Rutherford, M. and Attard, D. (2013) A retrospective cohort study describing admissions to a London trust’s PICU beds over one year: do men and women use PICU differently? Journal of Psychiatric Intensive Care. 9(1): 33–39. doi: 10.1017/S1742646412000167 Google Scholar
Stewart, D., Robson, D., Chaplin, R., Quirk, A. and Bowers, L. (2012) Behavioural antecedents to pro re nata psychotropic medication administration on acute psychiatric wards. International Journal of Mental Health Nursing. 21: 540–549. doi: 10.1111/j.1447-0349.2012.00834.x Google Scholar
Wright, S., Sayer, J., Parr, A., Gray, R., Southern, D. and Gournay, K. (2005) Breakaway and physical restraint techniques in acute psychiatric nursing: results from a national survey of training and practice. Journal of Forensic Psychiatry & Psychology. 16(2): 380–398. doi: 10.1080/14789940412331270735 Google Scholar