Rapid tranquillisation: an issue for all nurses in acute care settings
The management of challenging behaviour, violence and aggression is not only an issue for mental health and learning disability nurses. Increasingly, nurses working in emergency departments (EDs), medical assessment units and general medical or surgical wards may encounter acts of challenging behaviour, violence and aggression on a regular basis. Restraint is sometimes used as a tool in the management of these patients; this may be in the form of physical, mechanical or chemical restraint. Rapid tranquillisation (RT) is often considered a form of chemical restraint, which may be used in an emergency situation when prescribed. If RT is given it should be done so as the least restrictive option, with intramuscular and intravenous administration as a last resort. Patient monitoring following administration is paramount. This article explores best practice in the administration of RT from a clinical perspective.
The management of challenging behaviour, violence and aggression in emergency departments (EDs), and increasingly in general hospital wards, is often traumatic for both patients and the staff involved (Hext et al, 2018). Guidelines from the Department of Health (2014) stipulate the use of the least restrictive practices and interventions when caring for people who exhibit behaviour that may challenge staff and others. This article explores the role of nurses in relation to the administration of contemporary rapid tranquillisation as a restrictive intervention to manage aggression and violence in acute care settings. It will review drugs used, routes of administration, dosing, potential adverse effects and their management, and offer practical guidelines for acute care settings.
Specific training and education surrounding the causes and management of challenging behaviour, aggression and violence is essential for nurses working in all fields. An understanding of the biological causes of challenging behaviour is crucial, especially regarding reactive psychiatric symptoms and behavioural responses to pain, fear, infection or chronic disease. Patients with intellectual impairments, mental health problems and those with dementia or acute confusional states may be particularly prone to exhibiting challenging behaviour as a result of biological aetiology (Clark and Clarke, 2014). Healthcare staff should have an awareness of groups where there are known higher risks of violence and aggression such as young males, those with a forensic history and or/social restlessness, street drug and alcohol misusers, those with antisocial personality disorders or traits and those involved in gang culture (Mason and Chandley, 1999; Dickinson et al, 2018)
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