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A survey of the use of emergency parenteral medication at a secure psychiatric hospital

Published online by Cambridge University Press:  22 November 2012

Camilla Haw ,
Jean Stubbs  and
Simon Gibbon
Camilla Haw*
Affiliation:
St Andrew's Healthcare, Northampton, UK
Jean Stubbs
Affiliation:
St Andrew's Healthcare, Northampton, UK
Simon Gibbon
Affiliation:
St Andrew's Healthcare, Northampton, UK
*
Correspondence to: Dr Camilla Haw, Consultant Psychiatrist, St Andrew's Healthcare, Billing Road, Northampton, NN1 5DG. E-mail: [email protected]
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Abstract

Background

The use of additional sedative psychotropic medication to calm agitated or aggressive patients is known as rapid tranquillisation (RT). Several studies of RT practice have been conducted in psychiatric intensive care units (PICUs) and acute psychiatric settings.

Method

We carried out a cross-sectional survey of the use of parental sedation in an English secure hospital using data from medication charts and case notes.

Results

We studied the medication charts of 316 patients and found 203 incidents (all involving intramuscular route) of parenteral sedation involving just 35 patients. The vast majority (30; 85.7%) of those administered parenteral sedation were female and most (23; 65.7%) had emotionally unstable personality disorder. The most common indication was self-harm (44; 21.7%). In 24 (11.8%) instances the patient had requested an injection. A single drug was administered in 159 (78.3%) cases. The most commonly administered drug was lorazepam (152 cases) followed by haloperidol (69) and olanzapine (21). Case note documentation was frequently inadequate and in very few cases was there evidence of physical monitoring.

Conclusions

The use of parenteral sedation was rather different from that previously described in PICUs. Hospital policy and NICE guidance were not always being followed. Measures to rectify these deficits are being taken.

Keywords

Rapid tranquillisationantipsychoticbenzodiazepinesecure unitsurvey
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 9 , Issue 2 , August 2013 , pp. 77 - 84
Copyright
Copyright © NAPICU 2012 

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References

Alexander, J., Tharyan, P., Adams, C., John, T., Mol, C., Philip, J. (2004) Rapid tranquillisation of violent or agitated patients in a psychiatric emergency setting. British Journal of Psychiatry. 185: 63–69.Google Scholar
Brown, S., Chhina, N., Dye, S. (2010) Use of psychotropic medication in seven English psychiatric intensive care units. The Psychiatrist. 34: 130–135.Google Scholar
Davies, J., Oldfield, K. (2009) Treatment need and provision in medium secure care. British Journal of Forensic Practice. 11: 24–31.CrossRefGoogle Scholar
Dolan, M. (2001) Characteristics and outcomes of patients admitted to a psychiatric intensive care unit in a medium secure unit. The Psychiatrist. 25: 296–299.Google Scholar
Haw, C., Stubbs, J., Bickle, A., Stewart, I. (2011) Coercive treatments in forensic psychiatry: a study of patients’ experiences and preferences. Journal of Forensic Psychiatry and Psychology. 22: 564–585.CrossRefGoogle Scholar
Huf, G., Coutinho, E.S.F., Adams, C.E. (2007) Rapid tranquillisation in psychiatric emergency settings in Brazil: pragmatic randomised controlled trial of intramuscular haloperidol versus intramuscular haloperidol plus promethazine. BMJ. 335: 869.Google Scholar
Joint Formulary Committee (2011) British National Formulary, 62nd ed. London: BMJ Group and Pharmaceutical Press.Google Scholar
McAllister-Williams, R.H., Ferrier, I.N. (2002) Rapid tranquillisation: time for a reappraisal of options for parenteral therapy. British Journal of Psychiatry. 180: 485–489.Google Scholar
McLaren, S., Browne, F.W.A., Taylor, P.J. (1990) A study of psychotropic medication given ‘as required’ in a regional secure unit. British Journal of Psychiatry. 156: 732–735.Google Scholar
National Institute for Clinical Excellence (2005) Violence: The short term management of disturbed and violent behaviour in inpatient psychiatric settings and emergency departments. Clinical Guideline 25. London: NICE, 83 pp.Google Scholar
National Institute for Health and Clinical Excellence (2009) Schizophrenia: Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. Clinical Guideline 82. London: NICE.Google Scholar
Pereira, S., Paton, C., Walkert, L.M., Shaw, S., Gray, R., Wildgust, H. (2005) Treatment of acute behavioural disturbance: a UK national survey of rapid tranquillisation. Journal of Psychiatric Intensive Care. 1(2): 84–88.CrossRefGoogle Scholar
Pilowsky, L.S., Ring, H., Shine, P.J., Battersby, M., Lader, M. (1992) Rapid tranquillisation: a survey of emergency prescribing in a general psychiatric hospital. British Journal of Psychiatry. 160: 831–835.Google Scholar
Pratt, J.P., Chandler-Oatts, J., Nelstrop, L., Branford, D., Pereira, S. (2008) Establishing gold standard approaches to rapid tranquillisation: a review and discussion of the evidence on the safety and efficacy of medications currently used. Journal of Psychiatric Intensive Care. 4: 43–57.CrossRefGoogle Scholar
Ray, W.A., Meredith, S., Thapa, P.B., Meador, K.G., Hall, K., Murray, K.T. (2001) Antipsychotics and the risk of sudden cardiac death. Archives of General Psychiatry. 58(12): 1161–1167.CrossRefGoogle ScholarPubMed
SPSS (2009) PASW for Windows Release 18.0. Chicago: SPSS Inc.Google Scholar
Taylor, D., Paton, C., Kapur, S. (2012) The Maudsley Prescribing Guidelines in Psychiatry, 11th ed. Chichester: Wiley-Blackwell.Google Scholar
TREC Collaborative Group (2003) Rapid tranquillisation for agitated patients in emergency psychiatric patient rooms: a randomised trial of midazolam versus haloperidol plus promethazine. British Medical Journal. 327: 708–711.Google Scholar
Tuddenham, L., Logan, J. (2005) Psychotropic drugs given for aggressive incidents in a special hospital. Journal of Forensic Psychiatry and Psychology. 16: 85–91.CrossRefGoogle Scholar