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Rapid Tranquilisation
Background • Pharmacological method of managing uncontrollable violent or aggressive patients. • Primarily used within psychiatric in patient centres • Used commonly in patients with schizophrenia and substance abuse.
Public Health Implications • Prevents patients harming themselves. • Protects the general public, other patients and staff.
Drugs • Drugs recommended for use included: – IM Lorazepam – IM Haloperidol – IM Olazapine – IM Haloperidol and IM Lorazepam in combination.
Dangers • Potential dangers posed to both the patient themselves, and those surrounding them. • Patients tend to be agitated, in a state of acute distress • The drugs used have potentially serious and fatal complications; – – – –
Respiratory depression Cardiotoxicity Coma Sudden death
Guidelines • Ensure safe practice – before – during – after rapid tranquilisation.
• Protection for – the patient – staff members.
How well are the staff of Leeds Mental Health Trust adhering to the guidelines?
Recommendations • Universal care plan – to be filled put each time a patient under goes rapid tranquilisation – should include • indications for RT • drug administered, dose and route • monitoring of pulse rate, blood pressure, respiration rate, arousal rate and fluid input and output • reminder that this should be done every 10 minutes
• Prescription of Acuphase (zuclopenthixol acetate) – intervention to ensure its correct use – ensure the patient has had previous exposure to antipsychotics – prescription of Acetate dependent upon verbal discussion between pharmacist and senior staff member (consultant or senior registrar)
• Improve patient identification – for re-auditing and further audits – e.g. log book to be kept on the ward, each time a patient is tranquilised date of the procedure and patient number recorded – OR removable slip incorporated into the universal care plan.
Conclusions • Strengths – first audit of its kind – objective audit tool – sampled patients taken from variety of different wards
• Weaknesses – partial audit only – number of RT episodes limited – PICU – problems encountered when searching for information – errors during data collection
How not to carry out rapid tranquillisation
Starring . . . . .
As a psychiatric inpatient . . . Danny “the terror” Jones
Nurse Andy “couldn’t care less” Craig
Dr Phil “muscles from brussels” Cox
The patient reacted badly to Holland’s shock defeat at the hands of Russia in Euro 2008
There was no attempt to deescalate the situation
Dr Cox was never called
Unnecessary heavyhandedness was used by Dr Cox and Nurse Andy (trained in the martial arts!!)
Dr Cox showed all those hours in the gym were well spent as he hung the patient upside down in an attempt to calm him down
When it was decided that medication was needed. . . . Nurse Andy made an attempt at intravenous cannulation and received a blow to the head
After this attempt failed it was decided that I.M. Acuphase would be administered
Unfortunately this is not a rapidly acting drug and the patient continued to run riot
Once Danny was finally sedated Nurse Andy did not monitor the Patient, instead choosing to listen to S club 7 and read the latest edition of Heat magazine
And after the event there was no other documentation completed and Nurse Andy went wild with the remaining acuphase
Rapid tranquillisation according to the Leeds Mental Health Trust Guidelines
The patient reacted badly to Holland’s shock defeat at the hands of Russia in Euro 2008
Nurse Andy attempted to deescalate the patient by talking to him and offering him a very MAN-ly hug
Dr Cox was called and quickly rushed to the ward, bulging biceps n all!
Nurse Andy checked the patients notes looking for advanced statements or evidence of past medication
The correct drug was chosen by Dr Cox and Nurse Andy using the British National Formulary
The right drug at the correct dose (calculated as a percentage of the BNF maximum) was quickly administered intramuscularly
Nurse Andy made regular observations of blood pressure . . .
. . . . temperature . . . .
. . . and pulse.
These observations were carried out at 10 minutes intervals!
After the event both the patient and Nurse Andy had the chance to discuss what happened with a highly skilled councillor
When it had all quietened down Dr Cox went back to the gym, (of course) while nurse Andy and the patient stayed on the ward and made up!
Background • Pharmacological method of managing uncontrollable violent or aggressive patients. • Primarily used within psychiatric in patient centres • Used commonly in patients with schizophrenia and substance abuse.
Public Health Implications • Prevents patients harming themselves. • Protects the general public, other patients and staff.
Drugs • Drugs recommended for use included: – IM Lorazepam – IM Haloperidol – IM Olazapine – IM Haloperidol and IM Lorazepam in combination.
Dangers • Potential dangers posed to both the patient themselves, and those surrounding them. • Patients tend to be agitated, in a state of acute distress • The drugs used have potentially serious and fatal complications; – – – –
Respiratory depression Cardiotoxicity Coma Sudden death
Guidelines • Ensure safe practice – before – during – after rapid tranquilisation.
• Protection for – the patient – staff members.
How well are the staff of Leeds Mental Health Trust adhering to the guidelines?
Recommendations • Universal care plan – to be filled put each time a patient under goes rapid tranquilisation – should include • indications for RT • drug administered, dose and route • monitoring of pulse rate, blood pressure, respiration rate, arousal rate and fluid input and output • reminder that this should be done every 10 minutes
• Prescription of Acuphase (zuclopenthixol acetate) – intervention to ensure its correct use – ensure the patient has had previous exposure to antipsychotics – prescription of Acetate dependent upon verbal discussion between pharmacist and senior staff member (consultant or senior registrar)
• Improve patient identification – for re-auditing and further audits – e.g. log book to be kept on the ward, each time a patient is tranquilised date of the procedure and patient number recorded – OR removable slip incorporated into the universal care plan.
Conclusions • Strengths – first audit of its kind – objective audit tool – sampled patients taken from variety of different wards
• Weaknesses – partial audit only – number of RT episodes limited – PICU – problems encountered when searching for information – errors during data collection
How not to carry out rapid tranquillisation
Starring . . . . .
As a psychiatric inpatient . . . Danny “the terror” Jones
Nurse Andy “couldn’t care less” Craig
Dr Phil “muscles from brussels” Cox
The patient reacted badly to Holland’s shock defeat at the hands of Russia in Euro 2008
There was no attempt to deescalate the situation
Dr Cox was never called
Unnecessary heavyhandedness was used by Dr Cox and Nurse Andy (trained in the martial arts!!)
Dr Cox showed all those hours in the gym were well spent as he hung the patient upside down in an attempt to calm him down
When it was decided that medication was needed. . . . Nurse Andy made an attempt at intravenous cannulation and received a blow to the head
After this attempt failed it was decided that I.M. Acuphase would be administered
Unfortunately this is not a rapidly acting drug and the patient continued to run riot
Once Danny was finally sedated Nurse Andy did not monitor the Patient, instead choosing to listen to S club 7 and read the latest edition of Heat magazine
And after the event there was no other documentation completed and Nurse Andy went wild with the remaining acuphase
Rapid tranquillisation according to the Leeds Mental Health Trust Guidelines
The patient reacted badly to Holland’s shock defeat at the hands of Russia in Euro 2008
Nurse Andy attempted to deescalate the patient by talking to him and offering him a very MAN-ly hug
Dr Cox was called and quickly rushed to the ward, bulging biceps n all!
Nurse Andy checked the patients notes looking for advanced statements or evidence of past medication
The correct drug was chosen by Dr Cox and Nurse Andy using the British National Formulary
The right drug at the correct dose (calculated as a percentage of the BNF maximum) was quickly administered intramuscularly
Nurse Andy made regular observations of blood pressure . . .
. . . . temperature . . . .
. . . and pulse.
These observations were carried out at 10 minutes intervals!
After the event both the patient and Nurse Andy had the chance to discuss what happened with a highly skilled councillor
When it had all quietened down Dr Cox went back to the gym, (of course) while nurse Andy and the patient stayed on the ward and made up!
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