Use of psychotropic medication in seven English psychiatric intensive care units

Brown, Sarah; Chhina, Navjyoat; Dye, Stephen

doi:10.1192/pb.bp.108.023762

Cited by 21 publications

(9 citation statements)

References 15 publications

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“…Participants reported inadequate knowledge of evidenced-based chemical restraint practices substantiated in their descriptions of practices contradictory to research evidence. The current study findings are consistent with those of previous researchers who claimed that mental health nurses' medication practices and choices often were based on unit culture (Brown et al, 2010) and tradition (Stewart et al, 2012). Few descriptions were provided of the negative impacts of chemical restraint.…”

Section: Supporting Medication Best Practicessupporting

confidence: 90%

Putting Restraint on Chemical Restraint: Exploring the Complexity of Acute Inpatient Mental Health Nurses' Experience of Chemical Restraint Interventions

Danda

2020

CJCND

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While there is a growing body of research available on general restraint intervention in acute adult psychiatric settings, relatively little is known about nurses’ experiences of administering chemical restraint. The research question explored in this study was: what are mental health nurses’ experiences of using chemical restraint interventions in times of behavioural emergency on adult inpatient acute mental health units? Through this Canadian study understanding of direct care nurses’ first-hand experiences of the use of chemical restraint interventions was sought. Eight adult acute inpatient mental health nurses were interviewed using hermeneutic phenomenological method. Two major themes that emerged from data analysis are explored to illuminate the existing tension between therapeutic, person-centred care and coercive control to maintain safety: taking control to maintain safety and working within constraints. Integral ways that nurses make meaning from administering chemical restraint were found, as well as some of the complex clinical and ethical decision-making aspects involved in psychiatric nursing care. Implications for practice, education, and policy are discussed. Research findings indicated a need for further focus on medication best practice, policy development and nurse education. These exploratory research findings can be used to both inform and challenge dominant inpatient mental health practice to guide nurses, health care leaders, and policy makers by increased understanding of the complex ethical decision making required for use of chemical restraint interventions.

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Section: Supporting Medication Best Practicessupporting

confidence: 90%

Putting Restraint on Chemical Restraint: Exploring the Complexity of Acute Inpatient Mental Health Nurses' Experience of Chemical Restraint Interventions

Danda

2020

CJCND

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“…RT as defined by our criterion of 'the administration of any type of PRN intramuscular injection' was relatively low (13%) and almost half the rate found in Brown et al's (2010) study of seven PICUs in England (found to be 22%). Only one administration of zuclopenthixol acetate occurred compared to Brown et al's 17%.…”

Section: Discussionmentioning

confidence: 57%

The administration of psychotropic PRN medication in Scottish psychiatric intensive care units

Akram

Slevin

Davies

2014

J. Psychiatr. Intensive Care

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Information concerning the administration of psychotropic PRN medication in Scottish PICUs is scarce. The medical notes and prescription charts of all patients (n = 75) admitted during the study period were consulted to determine the frequency and nature of PRN practice. 65% of patients (n = 49) were administered up to 11 drugs comprising of antipsychotics (n = 8), benzodiazepines (n = 2) and zopiclone. The most frequently administered PRN medicines were lorazepam, haloperidol and zuclopenthixol. The mean dose administered for oral and intramuscular (IM) forms of both lorazepam and haloperidol were very similar. The mean number of PRN administrations per patient per day was 0.4. 40% of psychotropic PRN administrations were initiated by the nurse with the majority of doses administered at bedtime. Ten patients received an IM injection. Four patients were restrained during these administrations. Documentation pertaining to the rationale for IM administrations and of pre and post rapid tranquillisation physical health monitoring was lacking. This study highlights variation in practice between units, inadequate monitoring and documentation, a possible lack of understanding by prescribers of the differences in bioavailability between oral and injectable forms of medication and relatively limited use of newer drugs

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“…This has been highlighted by the results of a recent multi-centre survey which involved mainly units that participated in the network process (Brown et al, 2008;Brown et al, 2010;). Recognising this, the then National Institute for Mental Health in England (NIMHE) helped fund NAPICU to deliver a clinical governance network process which specifically focused upon development of quality within four specific spheres of PICU / low secure care .…”

Section: Why?mentioning

confidence: 99%

Psychiatric intensive care accreditation: The development of AIMS-PICU

Dye

Page²,

Deacon

et al. 2010

Journal of Psychiatric Intensive Care

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Use of psychotropic medication in seven English psychiatric intensive care units

Cited by 21 publications

References 15 publications

Putting Restraint on Chemical Restraint: Exploring the Complexity of Acute Inpatient Mental Health Nurses' Experience of Chemical Restraint Interventions

Putting Restraint on Chemical Restraint: Exploring the Complexity of Acute Inpatient Mental Health Nurses' Experience of Chemical Restraint Interventions

The administration of psychotropic PRN medication in Scottish psychiatric intensive care units

Psychiatric intensive care accreditation: The development of AIMS-PICU

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