Hostname: page-component-77c89778f8-5wvtr Total loading time: 0 Render date: 2024-07-23T18:08:05.292Z Has data issue: false hasContentIssue false
  • English
  • Français

Twenty four hour medical emergency response teams in a mental health in-patient facility – New approaches for safer restriant

Published online by Cambridge University Press:  19 January 2007

Alan Metherall ,
Raili Worthington  and
Alan Keyte
Alan Metherall
Affiliation:
Wotton Lawn Hospital, Horton Road, Gloucester, UK
Raili Worthington
Affiliation:
Wotton Lawn Hospital, Horton Road, Gloucester, UK
Alan Keyte
Affiliation:
Wotton Lawn Hospital, Horton Road, Gloucester, UK
Get access

Abstract

The National Institute for Clinical Excellence (2005) published guidance on the management of disturbed behaviour in mental health settings and emergency departments. The guidance included some of the recommendations made in the Independent Inquiry into the death of David Bennett (2003). One important recommendation requires that staff implementing physical interventions (restraint) and/or parenteral rapid tranquilisation are able to effectively manage the physical health of the patient including any immediate complications that may arise.

This article provides background and a syllabus for training for staff to be able to meet the physical assessment skills and interventions required by recent UK national guidance. Also reported is the creation, role and deployment of a 24-hour Medical Emergency Response Team in an in-patient mental health setting to ensure responses to both medical and psychiatric emergencies offer improved safety and adhere to the new guidance. The article describes the provision of a person with the sole responsibility monitoring a patients physical safety during restriant, 24 hour a day, 7 days a week.

The article will be of interest to those working in in-patient mental health and learning disability services, especially those where they are not served by a resuscitation team as part of a District General Hospital and where there is no resident Duty Medical Officer.

Keywords

Physical restraintphysical interventionrapid tranquilisationpsychiatric emergencymedical emergency
Type
Research Article
Information
Journal of Psychiatric Intensive Care , Volume 2 , Issue 1 , June 2006 , pp. 21 - 29
Copyright
© 2006 NAPICU

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beer, D., Turk, V., McGovern, P., Gravestock, S.M., Brooks, D., Barnett, L. and Orr, D. (2005) Characteristics of Low Secure Units in an English region: audit of twenty mental health and learning disabilities units for patients with severe challenging behaviour. Journal of Psychiatric Intensive Care. 1(1): 25–28.Google Scholar
Bristow, P.J., Hillman, K.M., Chey, G., Daffurn, K., Jacques, T.C., Norman, S.L., Bishop, G.F. and Simmons, E.G. (2000) Rates of in-hospital arrests, deaths and intensive care admissions: the effects of a medical emergency team. Medical Journal of Australia. 173(5): 236–240.Google Scholar
Daffurn, K., Lee, A., Hillman, K.M., Bishop, G.F. and Bauman, A. (1994) Do nurses know when to summon emergency assistance? Intensive Critical Care Nursing. 10: 115–120.Google Scholar
Department of Health (2004) A Compendium of Solutions to Implementing the Working Time Directive for Doctors in Training from August 2004. Department of Health Publications, London.
Goldhill, D.R., Worthington, L., Mulcahy, A., Tarling, M. and Sumner, A. (1999) The patient-at-risk team: identifying and managing seriously ill ward patients. Anaesthesia. 54(9): 853–860.Google Scholar
Hall-Smith, J., Ball, C. and Coakley, J. (1997) Follow-up services and the development of a clinical nurse specialist in intensive care. Intensive and Critical Care Nursing. 13(5): 243–248.Google Scholar
Independent Inquiry Report into the Death of David Bennett (2003) Norfolk, Suffolk and Cambridgeshire Strategic Health Authority. http://www.nscsha.nhs.uk
Kaplan, S. and Wheeler, E. (1983) Survival skills for working with potentially violent clients. Social Casework. 64(6): 339–346.Google Scholar
Keyte, A. and Worthington, R. (2005) Medical Emergency Response Training, Gloucestershire Partnership NHS Trust, unpublished document.
Kouwenhoeven, W.B., Jude, J.R. and Knickerbocker, G.C. (1960) Closed chest cardiac massage. Journal of American Medical Association. 173: 1064–1067.Google Scholar
Leadbetter, D. and Paterson, B. (2004) Developing an agency approach to safe physical intervention. Nursing & Residential Care. 6(6): 280–283.Google Scholar
Lilford, R. (2003) Teaching life support and resuscitation competencies in health care – Current practice and strategies for future research, unpublished document. http://www.pcpoh.bham.ac.uk/publichealth/psrp/Pdf/LIST_MASTER.pdf
Miles, S.H. and Irvine, P. (1992) Deaths caused by physical restraint. The Gerontologist. 32(6): 762–766.Google Scholar
McQuillan, P., Pilkington, S., Allan, A., Taylor, B., Short, A., Morgan, G., Nielsen, M., Barrett, D., Smith, G. and Collins, C.H. (1998) Confidential inquiry into quality of care before admission to intensive care. British Medical Journal. 316(7148): 1853–1858.Google Scholar
National Institute of Clinical Excellence (2005) Violence – The Short-term Management of Disturbed/Violent Behaviour in In-patient Psychiatric Settings and Emergency Departments. Clinical Guideline 25. National Institute for Clinical Excellence, London. http://www.nice.org.uk/pdf/cg025niceguideline.pdf
National Institute of Mental Health England (NIMHE) (2004) Developing Positive Practice to Support the Safe and Therapeutic Management of Aggression and Violence in Mental Health In-patient Settings. Mental Health Policy Implementation Guide. Department of Health, London.
Parkes, J. (2002) A review of the literature on positional asphyxia as a possible cause of sudden death during restraint. The British Journal of Forensic Practice. 4(1): 24–30.Google Scholar
Paterson, B., Bradley, P., Cameron, S., Sadler, D., Leadbetter, D. and Allen, D. (2003a) Deaths associated with restraint use in health and social care in the UK: the results of a preliminary survey. Journal of Psychiatric and Mental Health Nursing. 10: 3–15.Google Scholar
Paterson, B., Bradley, P., Cameron, S., Sadler, D., Leadbetter, D. and Allen, D. (2003b) Restraint related deaths in health and social care in the UK: learning the lessons. Mental Health Practice. 6(9): 10–17.Google Scholar
Paterson, B. and Leadbetter, D. (2004) Learning the lessons. Mental Health Practice. 7(7): 12–15.Google Scholar
Resuscitation Council (UK) (2002) Immediate Life Support Course. http://www.resus.org.uk/pages/ilsgen.htm
Resuscitation Council (UK) (2004) Cardiopulmonary Resuscitation. Standards for Clinical Practice and Training. Resuscitation Council, http://www.resus.org.uk/pages/standard.pdf, ISBN: 1-903812-09-7.
Resuscitation Council (UK) (2005) Resuscitation Guidelines. London ISBN 1-903812-10-0.
Schein, R.M.H., Hazday, N., Pena, M., Ruben, B.H. and Spring, C.L. (1990) Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 6(98): 1388–1392.Google Scholar
Smith, G. (2003) ALERT – Acute Life Threatening Events – Recognition and Treatment. Learning Media Development, University of Portsmouth.
Stenhouse, C. and Cunningham, M. (2002) Guidelines for the Introduction of Outreach Services. Intensive Care Society, London. http://www.ics.ac.uk/downloads/icsstandards-outreach.pdf
Wright, S. (1999) Physical restraint in the management of violence and aggression in in-patient settings: a review of issues. Journal of Mental Health. 8(5): 459–472.Google Scholar

A correction has been issued for this article:

Erratum