Issues on sedating mental patients

It is not licensed for this indication, but its efficacy has been demonstrated both as monotherapy and in conjunction with haloperidol.Promethazine has a slower onset of action than other options, such as intramuscular lorazepam, which can be problematic if the patient is being restrained.Oral promethazine is not recommended for this indication as it has a slow onset of action.Aripiprazole, given by intramuscular injection, has a weaker evidence base for efficacy in rapid tranquillisation than other, more established medicines.NICE uses the term ‘rapid tranquillisation’ to define using medicines parenterally to reduce the risk of harm and minimise agitation and violence.A small range of medicines are available for oral or parenteral, usually intramuscular, administration.This is because it can increase the QT interval, which could lead to cardiac arrhythmias or torsades de pointes, and can also cause extrapyramidal side effects.

The use of medicines could potentially be considered alongside any of these options.It can include grabbing, biting, punching, or self-injury, there were a total of 68,683 assaults against NHS staff in 2013–2014, with 53,484 incidents involving medical factors where the perpetrator did not know what they were doing.Some patients require restraint, and most incidents requiring a patient’s restraint occur in acute medical wards.However, if someone does not have the capacity to make decisions, the safeguards outlined in the Mental Capacity Act 2005 should be followed.Whichever route is chosen, the medicine needs to have a very rapid onset of action, with an effect lasting for just a few hours.

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