Event sequencing of forced intramuscular medication in England

Abstract

In most inpatient psychiatric care systems it is permissible in certain situations for staff to forcibly inject patients with psychotropic medication. The aim of this study is to describe what precedes and follows a coerced intramuscular injection within a nursing shift. Data were collected on the sequence of conflict (aggression, absconding, etc.) and containment (seclusion, restraint, etc.) for the first 2 weeks of 522 acute admissions on 84 wards in 31 UK hospitals. Injections were given to 9% of patients. Aggression, regular medication refusal and pro re nata (PRN) medication refusal preceded injections. The giving of coerced medication concluded most crises. Coerced medication effectively resolves crises in the short term. Staff should offer oral PRN as an alternative, unless this is unsafe. Where only verbal violence has occurred staff should try to resolve the crisis without enforcing medication. More research on the best way to respond to inpatients' medication refusal is required.

The relationship between attitudes towards different containment measures and their usage in a national sample of psychiatric inpatients

“…Additionally, if possible, patients should receive injections of IM medication in private. Bowers et al . (in press) collected data from psychiatric inpatient case notes from 31 hospitals in the south‐east of England to investigate the sequence of conflict and containment events.…”

Seclusion and Psychiatric Intensive Care Evaluation Study (SPICES): combined qualitative and quantitative approaches to the uses and outcomes of coercive practices in mental health services

“…The two are not mutually incompatible interventions and it is known that a small number of patients are given intramuscular medication as well as being secluded (5%), and more accept oral PRN medication during the seclusion process (24%). 74 The use of seclusion is also statistically associated with the use of coerced intramuscular medication. 2 The relative efficacy of coerced intramuscular medication and seclusion is not known, by any outcome indicator.…”

Rapid tranquilization: An audit of Irish mental health nursing practice

“…Our rate of 87% is higher than the 69% found in Bowers et al . 's () English study; however, forced intramuscular medication to manage aggression was one of the key factors in the use of RT in Raboch et al . 's study (Raboch et al .…”

“…No respondent used recently concocted terms such as ‘enforced/forced intramuscular medication’ (Bowers et al . ) or ‘coerced intramuscular IM medication’ (Whittington et al . ).…”