Current rapid tranquillisation documents in the UK: a review of the drugs recommended, their routes of administration and clinical parameters influencing their use

Abstract

BackgroundDespite not being underpinned by a strong evidence base, rapid tranquillisation is frequently the intervention of choice for dealing with violent and aggressive behaviour in psychiatric hospitals. This is the second of a two-part review of recommendations set out in UK trusts' adult rapid tranquillisation documents. In this article we focus on the drugs recommended, their routes of administration and clinical parameters influencing their use.MethodA review of adult rapid tranquillisation documents currently in use in NHS or HSC trusts providing adult mental health services in the UK.ResultsA total of 45 rapid tranquillisation documents met the inclusion criteria and were examined. Sixteen drugs were recommended, via four separate routes of administration. Beyond the use of oral and IM lorazepam, haloperidol and olanzapine there was no consensus as to which drugs should be used for rapid tranquillisation in adults. Eleven clinical decision-making parameters were identified that influenced the selection of drugs for IM administration. However, the wide variation and sometimes absence of advice surrounding these parameters was concerning.Conclusions and implications for clinical practiceThe results of this review demonstrate that there is a need to rationalise rapid tranquillisation and develop consensus guidelines that allow for evidence based decision-making tools.