Rapid tranquillisation
This care bundle describes six actions to ensure the best clinical outcome for patients who have received rapid tranquillisation medication. Care must be delivered in a safe and positive manner to ensure safe prescribing, administration and monitoring of medication used for calming behaviourally disturbed patients. Each described intervention will be required to be delivered, however these do not need to be completely sequentially.
Aim:
Support the Patient in developing coping strategies using the Positive PRN map before the use of PRN.
What to do:
Preplanning to include plan of care and other supporting care documentation and treatment following previous incidents to ensure RT is not the first approach for managing violence and aggression.
Patient should be assessed and non-pharmacological interventions used if possible before medication is to avoid the need for RT.
Consider physical causes such as delirium, medication induced confusion, or use of illicit substances.
Review and update risk assessment.
Aim:
Ensure timely and accurate record keeping. Develop robust systems for the use of RT and aftercare.
What to do:
Ensure all staff who will administer RT have completed RT training and support available from L&D training staff.
Ensure all staff involved in the use of RT have access to supervision and any learning needs are addressed.
Clear documentation on PARIS of rationale for the use of RT and actions following its administration.
Update and review the clinical documentation regularly including the care plan and risk assessment.
DATIX to be completed for all incidents involving RT.
NEWS2 form and all other related documents must be scanned into the electronic records in the Physical Healthcare tile using the title Rapid Tranquillisation.
Review and update risk assessment.
Aim:
Safe administration of RT which is trauma informed and prioritises the patient experience.
What to do:
Consider safety and appropriateness of the environment taking into account privacy and dignity.
Take patient choice into account when choosing injection site where possible.
Ensure all staff are trained to administer medication in the site chosen.
Follow manufacturer’s guidelines when preparing medication for administration.
Ensure correct PPE used.
Aim:
Develop a robust system that ensures that the patient’s physical health is monitored.
What to do:
Monitor and complete physical observations in line with policy using NEWS2
Consider any pre-existing physical health problems and monitoring of this.
Post RT physical health monitoring every 15 minutes for the first hour, then hourly for 3 hours. If results are normal, routine monitoring as per policy.
All monitoring to be completed on the NEWS2 form and then embed within the electronic system.
If patient refuses physical health monitoring, visual observation chart should be completed and uploaded.
Aim:
Foster a multi-disciplinary approach to care planning for the use of RT.
What to do:
Clinical review within 24 hours including Nursing staff and medical team to review care plan, type of RT used and future plans to manage risk including alternatives to RT.
Feedback from clinical review to be included in care plan and risk assessment.
Discuss the use of RT in the next MDT ward round/Clinical team review for the patient.
Formulation of risks to assess the need for RT and explore possible alternatives.
Assess effectiveness of current care plan – consider diagnosis.
Consider level of support required by staff/patient following any incident for psychological impact and physical injuries.
Ongoing review of medication and routine treatment and any possible interactions.
Aim:
Support the patient and carer(s) following use of RT and support all involved to develop understanding of what happened.
What to do:
Staff to carry out immediate post-incident debrief as described in P&PS Training.
Review incident that led to RT with the patient, carer and/or advocate and signpost to additional support.
Review the positive behavioural support plan, advanced directives and other clinical documentation.
Ensure witnesses are given the opportunity to reflect on their experience of the incident.
Feedback from debriefs to be included in care plan and risk assessment.
Ensure all staff involved have access to supervision.
Identify training needs.