Neuroleptic drug use in psychiatric intensive therapy units: problems with complying with the consensus statement

Hillam, Jonathan; Evans, Chris

doi:10.1192/pb.20.2.82

Cited by 10 publications

(7 citation statements)

References 10 publications

(3 reference statements)

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“…Research by Cornwall et al . (1996) and Hillam & Evans (1996) concentrated specifically on the use of high‐dose medication on PICUs. Both writers refer to the Royal College of Psychiatrists’ (1993) opinion that high‐dose treatment is not always fully justified and refer also to the college's guidance on prescribing above BNF limits.…”

Section: Care and Treatment On The Picumentioning

confidence: 99%

“…'s (1996) study demonstrated improvement in clinical practice and the use of high‐dose medication following implementation of a local protocol derived from the college guidelines. Hillam & Evans (1996) discuss the difficulties in dosage monitoring on a PICU due to the use of depot neuroleptics, clopixol acuphase or polypharmacy.…”

Section: Care and Treatment On The Picumentioning

confidence: 99%

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Philosophy, care and treatment on the psychiatric intensive care unit: themes, trends and future practice

Crowhurst

Bowers

2002

Psychiatric Ment Health Nurs

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Psychiatric intensive care units (PICUs) were first developed in the UK in the early 1970s and have become an integral part of inpatient services. This paper reviews all aspects of PICU provision from its origins to the most recent studies of intensive care treatment and philosophy. A search of CINAHL, MEDLINE and British Nursing Index databases revealed ample research and discussion papers from the past 30 years to permit a thorough review of the available literature. This divides roughly into discussion and descriptive research on topics related to: (a) the infrastructure of PICUs, including bed numbers, staffing levels, admission criteria and aspects of the physical environment; and (b) the treatment provided to patients on the PICU, both pharmacological and psychosocial, plus a limited amount of evaluative research on the efficacy of PICU care. This paper provides a summary and overview of these issues based upon currently available literature. It concludes that there is strong evidence for wide variation in the provision and nature of PICU care, reflecting idiosyncratic and localized development of services. Moreover, there is an almost complete lack of evidence on the efficacy of PICU care for particular types of patients and problems, leaving a paucity of research upon which PICU infrastructure, policy and therapeutic approach can be based.

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Section: Care and Treatment On The Picumentioning

confidence: 99%

Section: Care and Treatment On The Picumentioning

confidence: 99%

Philosophy, care and treatment on the psychiatric intensive care unit: themes, trends and future practice

Crowhurst

Bowers

2002

Psychiatric Ment Health Nurs

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“…medication while in psychiatric intensive care units (Cornwall et al . 1996; Hillam & Evans 1996). Curtis and Capp (2003) found that the main documented reason for administrating p.r.n.…”

Section: Discussionmentioning

confidence: 99%

P.r.n. medication use in a psychiatric high‐dependency unit following the introduction of a nurse‐led activity programme

Thomas

Jones

Johns

et al. 2006

Int J Mental Health Nurs

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This paper describes the introduction of a daily activity programme with clients who require psychiatric intensive care in two locked high-dependency units (HDUs). To evaluate the programme, a crossover study between the two units was undertaken with a convenience sample of clients. Baseline data of pro re nata (p.r.n.) medication dispensed to patients were collected for a period of 2 weeks from both locked units before the introduction of the programme. The programme was conducted for a period of 1 month in alternate locked units. Both non-intervention and active programme data were collected throughout the 6-month period of the study. Findings from the study demonstrated that an activity-based nursing intervention was effective in reducing the number of p.r.n. medications dispensed in a HDU compared with control conditions. The effects were statistically significant in one of the units and absent in the other. This study shows that a purposeful activity programme for severely disturbed psychiatric clients in a HDU setting can be effective in reducing disturbed behaviour and therefore the need for p.r.n. medication.

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“…Some (but not all) PICUs have a seclusion room for the isolation of those patients who cannot be safely managed on the ward. Treatment in PICUs has a strong emphasis on the use of medication (Cornwall et al . 1996, Hillam & Evans 1996).…”

Section: Introductionmentioning

confidence: 99%

Coercive manoeuvres in a psychiatric intensive care unit

Ryan

Bowers

2005

Psychiatric Ment Health Nurs

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Coercive manoeuvres in a psychiatric intensive care unit The practice of physical restraint techniques in the management of disturbed behaviour is a significant part of the role of mental health nurses, particularly in Psychiatric Intensive Care Units (PICUs). Debate about what constitutes good practice is intense, and the subject of recently issued guidelines by National Institute for Mental Health in England. However, the contribution of other forms of conflict management techniques has tended to be ignored. The purpose of this study was to identify, describe and categorize coercive manoeuvres used by nurses, and to examine the circumstances and appropriateness of their use. Non-participant observation of verbal and non-verbal interaction between patients and nurses during conflict situations was undertaken on one PICU. The critical incidents observed were identified, categorized and systematically recorded. Nurses used a variety of low level physical and interactional manoeuvres in order to manage patients' disturbed and resistive behaviour. These manoeuvres were seldom recorded, discussed or reviewed, although they were frequently used to manage critical conflict situations. These manoeuvres have neither been previously described nor evaluated. They may, in some cases, be useful substitutes for actual restraint, alternatively they may, in some cases, be judged undesirable. It is not known how widespread these practices are in acute psychiatry.

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Neuroleptic drug use in psychiatric intensive therapy units: problems with complying with the consensus statement

Cited by 10 publications

References 10 publications

Philosophy, care and treatment on the psychiatric intensive care unit: themes, trends and future practice

Philosophy, care and treatment on the psychiatric intensive care unit: themes, trends and future practice

P.r.n. medication use in a psychiatric high‐dependency unit following the introduction of a nurse‐led activity programme

Coercive manoeuvres in a psychiatric intensive care unit

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