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

What is it?

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How can you determine if a patient has capacity?

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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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