IntroductionIntramuscular (IM) medications used in rapid tranquillisation (RT) to manage violent/aggressive behaviour can cause serious physical side effects including sudden death, therefore comprehensive physical health monitoring is advised.ObjectivesTo assess whether physical health monitoring of patients who received IM medication for RT was completed as per the Aggression/Violence NICE-guideline based local Policy.MethodsAll patients that received IM benzodiazepines or antipsychotics for RT were identified amongst 822 discharges from February 2014 to February 2015. Demographics, diagnoses, non-pharmacological interventions, types/doses of medication, and associated seclusion/restraint episodes were recorded. Notes were examined to determine whether physical health monitoring protocols involving blood pressure, pulse, temperature, oxygen saturation, respiratory rate and level of consciousness were followed.ResultsThere were a total of 218 episodes where these medications were used, in which only 19 (8.8%) had any physical observations completed; only one case (0.5%) was completed fully as per the protocol. Of the cases that did not have observations taken, in 12 (5.5%) cases observations were attempted but the patient was too agitated/aggressive. A doctor was contacted in only 53 (24.3%) cases and an ECG was completed in 120 (55%) cases, of which only 11 were completed within 24 hours.ConclusionsThe results show poor compliance (or at least recording) with the guidance, demonstrating the need for further education of nursing and medical staff on the potential dangers of RT and for better physical health monitoring of patients on RT. To improve patient safety, staff training and well-timed recording of physical observations on electronic tablets will commence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depression is a common illness that can present in a variety of ways. Therefore, the current literature suggests taking a holistic approach incorporating biological, psychological and social factors, and raising the index of suspicion for alternative explanations in an atypical case as this article illustrates.