Rapid tranquillisation of acutely disturbed and violent patients: a retrospective cohort examination of 24 patients on a psychiatric intensive care unit

Abstract

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.

Putting Restraint on Chemical Restraint: Exploring the Complexity of Acute Inpatient Mental Health Nurses' Experience of Chemical Restraint Interventions

“…Chemical restraint intervention was sometimes considered the only viable option to manage risks when caring for multiple patients experiencing multiple stressors, including substance cravings and acute mental illness symptoms of paranoia, boredom, lack of private space, and living amongst many angry and bored co-patients. The results echo the findings that specific interventions, such as chemical restraint, increase in prevalence due to multiple workplace challenges, including staff shortages and increasing incidence of patient violence (Cowin et al, 2003;Shahpesandy et al, 2015). Chemical restraint best practices must be designed to emphasize safe patient care, as well as to ameliorate the challenges posed by shortages of staffing, crowded units, and poor inpatient mental health unit design.…”