Giving medicines to quickly calm the severely agitated patient, in order to reduce the risk of imminent and serious violence to self or others, is referred to as rapid tranquillisation (RT).
Despite national guidelines on the management of violence, several Royal College of Psychiatrists guidelines, consensus statements, best practice guidelines, and numerous reviews of the evidence, there is no current consensus as to the first line pharmacological agent in RT.
Over the last few years there have been a number of new medicines for RT, new formulations, and new evidence. The discontinuation of droperidol injection led to more widespread use of haloperidol. The maximum dose of haloperidol has decreased, baseline ECGs are now recommended, and it is no longer licensed for IV administration. These developments have led to changes in RT practice.
In order to safely use the new medicines and new formulations it is imperative that all staff involved in prescribing and administration should be familiar with the practical use of these medicines. This includes methods of preparation and administration, specific side effects and monitoring requirements, as well as their own responsibilities in regard to these medicines.