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Rapid Tranquillisation [62]

Staff Training Requirements

 
These areas should form part of routine staff induction and regular training programmes wherever rapid tranquillisation is used
  • Anticipation of environment and communication factors
  • De-escalation
  • Physical Restraint
  • Use and dangers of rapid tranquillisation
  • Properties of benzodiazepines (Oral, IM and IV)
  • Use of flumanzenil (benzodiazepine antagonist)
  • Cardiopulmonary Resuscitation

Potential Risks

  • Over-sedation causing loss of consciousness
  • over-sedation loss of alertness
  • Possible damage to therapeutic relationship
  • Specific issues of diagnosis

Caution!
  • Do not use drug cocktails or high doses;
  • Keep to BNF doses
  • Use minimum effective dose
  • Do not seclude if service user is heavily sedated or using drugs/alcohol
  • If service user secluded, Increase Vigilance if using rapid tranquillisation
Consult
Advance Directives  if available

Preferred route of drug administration (1=preferred)

1. Oral
Lorazepam, olanzapine or haloperidol
If using haloperidol, consider anticholinergic
2. IM

Consider single drug rather than combination:

  • lorazepam, or
  • haloperidol, or
  • olanzapine
For urgent tranquillisation, consider haloperidol + lorazepam
When using conventional antipsychotic IM, also give an anticholinergic agent
Monitor Vital signs
3. IV (Only Exceptionally)
Monitor Vital signs
 
As soon as possible, give service user an opportunity to discuss the experience and provide clear explanation of decision to use rapid tranquillisation
         

When service is calm

Monitor for traumatic reactions
Consider allowing service user to write his/her account in his/her notes afterwards