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Establishing gold standard approaches to rapid tranquillisation:A review and discussion of the evidence on the safetyand efficacy of medications currently used

Published online by Cambridge University Press:  01 December 2008

J Peter Pratt ,
Jacqueline Chandler-Oatts ,
Louise Nelstrop ,
Dave Branford ,
Stephen Pereira  and
Susan Johnston
J Peter Pratt
Affiliation:
Chief Pharmacist, Sheffield Care Trust
Jacqueline Chandler-Oatts*
Affiliation:
Research Fellow, Royal College of Nursing Research Institute, Warwick University
Louise Nelstrop
Affiliation:
Research Fellow, Royal College of Nursing Institute, Oxford
Dave Branford
Affiliation:
Chief Pharmacist Derbyshire Mental Health Services NHS Trust
Stephen Pereira
Affiliation:
Consultant Psychiatrist, North East London Mental Health Trust
Susan Johnston
Affiliation:
Consultant Psychiatrist, Rampton Hospital, Nottinghamshire Healthcare NHS Trust
*
Correspondence to: J. Chandler-Oatts, Royal College of Nursing Research Institute at Warwick University, Whichford House, Oxford Business Park, Oxford, 0X4 2JY, UK. Tel: +44 (0) 1865 787115; Fax: +44 (0) 1865 787149; E-mail: jacqueline.chandler-oatts@rcn.org.uk
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Abstract

Background: Rapid tranquillisation is used when control of agitation, aggression or excitement is required. Throughout the UK there is no consensus over the choice of drugs to be used as first line treatment. The NICE guideline on the management of violent behaviour involving psychiatric inpatients conducted a systematic examination of the literature relating to the effectiveness and safety of rapid tranquillisation (NICE, 2005). This paper presents the key findings from that review and key guideline recommendations generated, and discusses the implications for practice of more recent research and information.

Aims: To examine the evidence on the efficacy and safety of medications used for rapid tranquillisation in inpatient psychiatric settings.

Method: Systematic review of current guidelines and phase III randomised, controlled trials of medication used for rapid tranquillisation. Formal consensus methods were used to generate clinically relevant recommendations to support safe and effective prescribing of rapid tranquillisation in the development of a NICE guideline.

Findings: There is a lack of high quality clinical trial evidence in the UK and therefore a ‘gold standard’ medication regime for rapid tranquillisation has not been established.

Rapid tranquillisation and clinical practice: The NICE guideline produced 35 recommendations on rapid tranquillisation practice for the UK, with the primary aim of calming the service user to enable the use of psychosocial techniques.

Conclusions and implications for clinical practice: Further UK specific research is urgently needed that provides the clinician with a hierarchy of options for the clinical practice of rapid tranquillisation.

Keywords

Rapid tranquillisationviolenceaggressionantipsychoticbenzodiazepine
Type
Review Article
Information
Journal of Psychiatric Intensive Care , Volume 4 , Issue 1-2 , December 2008 , pp. 43 - 57
Copyright
Copyright © NAPICU 2008

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