Journal of Psychiatric Intensive Care

Original Research Article

A review of the practice and position of monitoring in today’s rapid tranquilisation protocols

James Innesa1a3 c1 and Lynda Iyekea2a3

a1 Deputy Chief Pharmacist

a2 Senior Pharmacist

a3 East London NHS Foundation Trust, UK


Background: Rapid tranquilisation (RT) is one of the highest risk clinical procedures currently undertaken by mental health services, yet it is underpinned by a surprisingly weak evidence base. The evidence base is weaker still when applied to post RT monitoring.

Aims: To review current clinical monitoring practice contained within adult RT documents in the UK.

Method: A review of adult RT documents currently in use in NHS or HSC trusts providing adult mental health services in the UK.

Findings: A total of 44 RT documents were examined. A picture of wide ranging practice was observed that prevented us from undertaking a full analysis of the data collected. Even when analysis was confined to the intramuscular route, there were concerning differences between documents in: when monitoring was initiated; what was being monitored; and the frequency and duration of this monitoring.

Conclusions and implications for clinical practice: There is a fundamental need for consensus in this high risk practice. The College of Mental Health Pharmacists, Royal College of Nursing and Royal College of Psychiatrists should have a key role in fashioning this consensus in both practice and policy.


c1 Correspondence to: Mr James Innes, Mile End Hospital, Bancroft Rd, London, E1 4DG. E-mail: