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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

Please note OSCEstop content is for educational purposes only and not intended to inform clinical practice. OSCEstop and authors take no responsibility for errors or the use of any information displayed. Drugs and doses are intended for non-pregnant adults, who are not breastfeeding, with normal renal and hepatic function.

Test your knowledge on legal frameworks

Mental Capacity Act

What is it?

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How can you determine if a patient has capacity?

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What does it allow you to do?

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What documentation is required?

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Mental Health Act

What is it?

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List the commonly used Mental Health Act sections?

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What does it allow you to do?

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What documentation is required?

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