Journal of Psychiatric Intensive Care

Review Article

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

J Peter Pratta1, Jacqueline Chandler-Oattsa2 c1, Louise Nelstropa3, Dave Branforda4, Stephen Pereiraa5 and Susan Johnstona6

a1 Chief Pharmacist, Sheffield Care Trust

a2 Research Fellow, Royal College of Nursing Research Institute, Warwick University

a3 Research Fellow, Royal College of Nursing Institute, Oxford

a4 Chief Pharmacist Derbyshire Mental Health Services NHS Trust

a5 Consultant Psychiatrist, North East London Mental Health Trust

a6 Consultant Psychiatrist, Rampton Hospital, Nottinghamshire Healthcare NHS Trust

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.

Correspondence:

c1 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