The prevalence of violent behaviour within acute psychiatric services is about 10%.AimTo identify the pharmacological management of acutely disturbed behaviour in patients requiring rapid tranquillisation (RT) on a psychiatric intensive care unit (PICU). Socio-demographic and clinical characteristics were also identified in these patients.Method and objectivesA retrospective cohort examination was carried out of 24 patients receiving RT, average age of 38.8 years (7 women and 17 men), admitted to the PICU between 1 January 2011 and 31 December 2011. Patient records and hospital incident reporting system were used to obtain relevant data for analysis.ResultsThe majority of patients were detained (95%); suffering from schizophrenia (45.8%); bipolar disorder (25%) and substance misuse disorders (12.5%). Verbal aggression (58.3%) and threatening behaviour (29.2%) were the most common factors leading to RT. Fourteen patients (58.3%) were medicated with a combination of haloperidol and lorazepam; nine (37.5%) with zuclopenthixol acetate only; and one (4.2%) with a combination of zuclopenthixol and promethazine.ConclusionHaloperidol in combination with lorazepam was the most common medication utilised for RT. Nevertheless, zuclopenthixol acetate alone, or combined with other drugs, was used in over 40% of cases. This finding is in considerable variation with recommended guidelines.
Background:Prevalence of violent behaviour within acute psychiatric services is about 10%.Aims:To assess compliance of management of acutely disturbed patients with the National Institute for Health and Clinical Excellence (NICE) guidance for use of Rapid Tranquilisation (RT).How did we assess practice?:A sample of 24 patients admitted to local Psychiatric Intensive Care Unit (PICU) receiving RT during 2011 was assessed using retrospective analysis of records.Areas of Good Practice:100% compliance was achieved in many of the criteria assessed, including recording the risk assessment and management plan appropriately.Areas of concern:None of the patients had up-to-date advance directive detailing their preferred strategies in case of violent incidents.50% of patients had their baseline blood pressure, pulse, temperature and respiratory rate recorded and 33% at regular intervals.25% were debriefed and none offered an opportunity to write their account of RT.38% had their medication reviewed following RT.Other findings:46% were suffering from psychotic disorders; manic episode accounted for 25% of all patients.54% of all (65% of men) received Zuclopenthixol acetate for RT and 46% the combination of Haloperidol plus Lorazepam; however, the combination of Haloperidol plus Lorazepam was used in 71.4% of women and 35% of men.12.5% required a short period of seclusion.All patients were detained under the Mental Health Act.How we can make changes and improve practice?:Training of the PICU staff in the NICE Guidance: The short-term management of disturbed/violent behaviour in psychiatric inpatient settings and emergency departments.
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