EPA-1279 - Pharmacological management of aggression and violent behaviour : audit of rapid tranquilisation of acutely disturbed service-users in the psychiatric intensive care unit

Abstract

Prevalence of violent behaviour within acute psychiatric services is about 10%. To assess compliance of management of acutely disturbed patients with the National Institute for Health and Clinical Excellence (NICE) guidance for use of Rapid Tranquilisation (RT). A sample of 24 patients admitted to local Psychiatric Intensive Care Unit (PICU) receiving RT during 2011 was assessed using retrospective analysis of records. 100% compliance was achieved in many of the criteria assessed, including recording the risk assessment and management plan appropriately. None of the patients had up-to-date advance directive detailing their preferred strategies in case of violent incidents. 50% of patients had their baseline blood pressure, pulse, temperature and respiratory rate recorded and 33% at regular intervals. 25% were debriefed and none offered an opportunity to write their account of RT. 38% had their medication reviewed following RT. 46% were suffering from psychotic disorders; manic episode accounted for 25% of all patients. 54% of all (65% of men) received Zuclopenthixol acetate for RT and 46% the combination of Haloperidol plus Lorazepam; however, the combination of Haloperidol plus Lorazepam was used in 71.4% of women and 35% of men. 12.5% required a short period of seclusion. All patients were detained under the Mental Health Act. Training of the PICU staff in the NICE Guidance: The short-term management of disturbed/violent behaviour in psychiatric inpatient settings and emergency departments.