Book contents
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
101 - Rapid tranquillisation
from VII - Treatment
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
Summary
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.
- Type
- Chapter
- Information
- 101 Recipes for Audit in Psychiatry , pp. 233 - 234Publisher: Royal College of PsychiatristsPrint publication year: 2011