Rapid tranquilisation of agitated patient at risk to self/others

Ensure safety of patient and others

• Try to calm patient down
• Move patient to a safe place (or move other patients and staff)
• Call security to be in background and intervene if needed

Try alternative management first

• Turn on the lights 
• Explain where they are, the time and ascertain their concerns
• See if a relative can come in or has any advice
• Try verbal de-escalation, conflict resolution, positive behaviour

General points

• Only to be used as a last resort if an agitated patient is at risk to themselves or others
• It must be proportional to risk
• Use half doses in elderly or renal impairment
• Always offer oral route first
• Oral therapy takes 45-60 minutes to take effect; IM therapy takes 30 minutes
• Observations should be undertaken every 15-30 minutes
• Ensure you very clearly document what you have done and why (including why it was really necessary, how you tired to de-escalate prior to restraint, how/why the restraint was proportional to risk, and that you offered oral medications prior to IM etc.)
• Legal frameworks for restraint
  • Mental capacity act (for patients without capacity): allows restraint to protect self (not others)
  • Mental health act treatment sections (2/3; not 5): allow restraint to protect self and others
  • Common law: may be used for restraint to protect self/others in acute situations otherwise (but generally not recurrently)

Rapid tranquilisation protocol

Test your knowledge on legal frameworks

Mental Capacity Act

Mental Health Act