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

Background:

Prevalence of violent behaviour within acute psychiatric services is about 10%.

Aims:

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).

How did we assess practice?:

A sample of 24 patients admitted to local Psychiatric Intensive Care Unit (PICU) receiving RT during 2011 was assessed using retrospective analysis of records.

Areas of Good Practice:

100% compliance was achieved in many of the criteria assessed, including recording the risk assessment and management plan appropriately.

Areas of concern:

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.

Other findings:

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.

How we can make changes and improve practice?:

Training of the PICU staff in the NICE Guidance: The short-term management of disturbed/violent behaviour in psychiatric inpatient settings and emergency departments.