Setting

This audit is relevant to all acute in-patient services where high proportions of patients are acutely disturbed and present a risk to themselves or others.

Background

The use of rapid tranquillisation for acutely disturbed patients is at times necessary to ensure the safety of themselves or others. Documentation of the reasons for its use and commensurate physical health monitoring are vital to ensure patient safety and to facilitate improved ongoing care.

Standards

Standards were obtained from the guideline on the management of violence from the National Institute for Health and Clinical Excellence (NICE) (2005) and the Good Medical Practice guidelines (General Medical Council, 2009). Of particular relevance were the following:

ᐅ The intervention selected must be a reasonable and proportionate response to the risk posed by the services user.

ᐅ At all times, a doctor should be available to quickly attend an alert by staff members when rapid tranquillisation is implemented.

ᐅ Medications should be prescribed and administered as per Good Medical Practice.

ᐅ The prescriber and medication administrator should pay attention to consent.

ᐅ The physical health of patients should be monitored as per the rapid tranquillisation algorithm.

ᐅ Any incident requiring rapid tranquillisation should be recorded using a local template.

ᐅ A post-incident review should take place as soon as possible and at least within 72 hours of an incident ending.

The target is that these standards are met for all patients who have received rapid tranquillisation.

Method

Data collection

All medication charts were reviewed for a 4-week period to determine who had been given any p.r.n. medication relevant to rapid tranquillisation (e.g. haloperidol, lorazepam or olanzapine). Oral medication was included only if it was given as part of rapid tranquillisation. A pro forma was used for data collection and the medical notes of these patients were examined to find the entries documenting the following:

ᐅ ‘severe imminent’ risk to self or others

ᐅ whether a doctor was contacted

ᐅ what medication was administered

ᐅ whether consent had been given

ᐅ any physical health monitoring carried out after rapid tranquillisation

ᐅ completion of local rapid tranquillisation monitoring form and incident form

ᐅ whether there had been a debriefing with the patient within 72 hours of the incident.