Rapid Tranquilisation Policy for Adult Patients within ... · 2 Policy Title: Rapid Tranquilisation...

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Rapid Tranquilisation Policy for Adult Patients within East Cheshire

NHS Trust

2

Policy Title: Rapid Tranquilisation Policy for adult patients within

East Cheshire NHS Trust

Executive Summary: Agitated and aggressive behaviour from patients is common. Such behaviours increase the risk of harm to the patient themselves, other patients, and hospital staff. The clinical practice of restraint and, or rapid tranquilisation is used when psychological and behavioural approaches have failed to deescalate acutely disturbed behaviour. It is essentially a management strategy of last resort.

Supersedes: New Policy

Description of Amendment(s):

N/A

This policy will impact on: All Trust Staff

Financial Implications: None

Policy Area: Document Reference:

Version Number: 1.0 Effective Date: 1st August 2016

Issued By: Review Date: 31s July 2019

Authors: Lead Pharmacist – Urgent Care

Impact Assessment Date:

August 2016

APPROVAL RECORD

Committees / Group Date

Consultation: Medicines Management Group ED Consultants Adult safeguarding Lead

February 2016

Approved by: Medicines Management Group

July 2016

ECT002555

Pharmacy

Pharmacy

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CONTENTS Page

1.0 Introduction 4

2.0 Managing violence and aggression in emergency departments 4

2.1 Route of administration 4

2.2 Non-drug de-escalation approaches 4

2.3 Physical intervention 4

2.4 Overarching recommendations 5

3.0 Choice of Medication 5

3.1 Rapid Tranquilisation for 18-65 years 8

3.2 Rapid Tranquilisation for over 65 years 9

3.3 Rapid Tranquilisation for 18-65 years when Lorazepam IM Unavailable 10

3.4 Rapid Tranquilisation for over 65 years when Lorazepam IM Unavailable 11

4.0 Monitoring 12

5.0 Assessment 12

6.0 Remedial measures in Rapid Tranquilisation 12

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1.0 Introduction

Agitated and aggressive behaviour from patients is common. Such behaviours increase the

risk of harm to the patient themselves, other patients, and hospital staff. The clinical practice

of restraint and, or rapid tranquilisation is used when psychological and behavioural

approaches have failed to deescalate acutely disturbed behaviour. It is essentially a

management strategy of last resort.

The policy applies to:

• Inpatients only receiving care and treatment at East Cheshire NHS Trust

• Patients in the A and E department

Other policies to consider:

• ITU tranquilisation policy

• Restraint policy

2.0 Managing violence and aggression in emergency departments

If a patient with a mental health problem becomes aggressive or violent, do not exclude them

from the emergency department. Manage the violence or aggression in line with

recommendations within this policy and do not use seclusion. Regard the situation as a

psychiatric emergency and refer the patient to mental health services urgently for a

psychiatric assessment within 1 hour.

2.1 Route of administration

If possible an oral formulation should always be offered as first line therapy. If oral therapy is

refused or inappropriate medication should be administrated by intramuscular injection (IM)

with appropriate supervision and monitoring, as clarified by the recommendations in this

policy. It may be appropriate to use multiple medications by multiple routes of administration.

2.2 Non-drug de-escalation approaches

• Maintain adequate distance

• Ensure environment is conductive to calmness (e.g. low stimulation levels, noise,

other patients)

• Move to a safe place or seclude

• Explain intentions and be calm and self-assured

• Use non-threatening, non-verbal communication

• Converse and try to develop a therapeutic relationship throughout

2.3 Physical intervention

Where techniques have failed to calm a patient, it may be necessary as a last resort and in the

best interests of the patient to make use of additional interventions, such as physical

intervention, rapid tranquilisation and seclusion to manage the safety of the patient and those

around them. All such interventions should only be considered once all non-physical

interventions have been tried and have not succeeded in calming the patient. The choice of

intervention(s) will depend on a number of factors, but should be guided primarily by:

• Patient preference (if known) i.e. advance directives or lasting power of attorney;

• Management care plans or agreed pathways;

• Duty of care to other patients affected by the disturbed / violent behaviour;

• The protection of staff, patients and visitors;

• The facilities available within the particular setting.

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2.4 Overarching recommendations

Rapid tranquilisation, physical intervention and seclusion should only be considered once de-

escalation and other strategies have failed to calm the patient. These interventions are

emergency management strategies and are not regarded as primary treatment techniques.

When determining which interventions to employ, clinical need, safety of patients and others,

and, where possible, advance statements should be taken into account. The intervention

selected must be a reasonable and proportionate response to the risk posed by the patient.

3.0 Choice of Medication

Rapid tranquillisation is defined in this guideline as the administration of sedative medication,

although a number of effective agents are available for sedation, there is no evidence showing

clear superiority for any one agent. Therefore individualised treatment needs to be

emphasised, taking into account the patient's view, pre-existing physical health problems,

previous response to medications including adverse effects, the potential for interactions with

other medications, and the total daily dose of medications prescribed and administered.

Intramuscular lorazepam is recommended for patients who have not taken antipsychotic

medication before because it is an effective intervention that is likely to be acceptable to the

majority of patients. Prescribing the initial dose of rapid tranquillisation as a single dose will

ensure that any subsequent treatment options can be individualised, taking account of both

response and any emergent adverse effects of the initial treatment choice. When considering

rapid tranquilisation therapy medication should not routinely or automatically on admission,

there should be clarity about the rationale and circumstances in which medication should be

given. The maximum daily dos, appropriate interval and maximum daily dose should be

included on the prescription and different routes of administration of the same medication

should be prescribed separately.

Intramuscular olanzapine has been withdrawn from the UK market but it remains a licensed

product in the European Union (EU) and can therefore be imported from other countries.

Care must be taken when giving IM injections to patients who are highly aroused or

distressed and pose serious concerns to the safety of others or themselves. The provision of

adequate staff trained in approved care and responsibility techniques should always be on

standby even when patients agree to IM treatment, as there are the inadvertent risks of intra-

arterial injection, bolus dosing, nerve damage, bruising, needle breakage in patients who may

struggle or are resistive, and also a higher than expected absorption rate due to the increased

blood flow to the muscles in a highly aroused individual.

All staff should be aware of the “DO NOTS” involved in rapid tranquilisation:

• DO NOT mix medications in the same syringe;

• DO NOT use two or more antipsychotics at the same time;

• DO NOT use IM diazepam, which is erratically absorbed;

• DO NOT use IM chlorpromazine, which crystallises in the tissues and causes a

precipitous drop in blood pressure, especially in older patients;

• DO NOT administer IM olanzapine and IM benzodiazepines at the same time, leaving a

one hour gap after administering IM olanzapine;

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Table 1: Medicines used in rapid tranquilisation – their properties, cautions and advice notes

Medicine Route Pharmacokinetics Major Side

Effects

Notes

Lorazepam Oral or

IM

Onset 10 to 30 mins

Peak 60 to 90 mins

Half-life 12 to 16

hrs

- Respiratory

Depression

- Disinhibition

- IM absorption is as slow as oral absorption, but is rapid

in an active patient.

- The injection should be diluted 50:50 with water for

injections preinjection.

- There is no accumulation of lorazepam with repeated

doses or in impaired liver function- this makes it

advantageous over diazepam.

- A wide therapeutic index & respiratory depression is

readily reversed with the specific antagonist flumazenil.

- Disinhibition is more likely to occur in those with

organic brain disease, including learning disabilities, the

under 18s & the over 65s, & perhaps those with impulse

control problems.

- Simultaneous injection of parenteral benzodiazepines

and IM olanzapine is not recommended due to the

potential for excessive sedation, cardiorespiratory

depression and in very rare cases, death.

Haloperidol Oral Onset 1 to 2 hrs

Peak 4 hrs

Half-life 1 to 36 hrs

- EPSE

- Hypotension

- NMS

- Increased

QTc

or arrhythmias

- Seizures

- Sudden death

- The bioavailability of both formulations is different and

this must be

taken into account when considering the total dose per

24 hr period.

See table 2 for advice on this.

- Note risk of acute dystonias and ensure that an

appropriate antimuscarinic is available.

IM Onset 20 mins

Peak 1 hrs

Half-life 21 hrs

Olanzapine Oral Onset 5 to 8 hrs

Peak 5 to 8 hrs

Half-life 32 to 50

hrs

- Hypotension

- Bradycardia

- Syncope

- IM Olanzapine is only available as an unlicensed

formulation

- Less likely to cause EPSE than haloperidol.

- IM administration results in initial maximum plasma

concentration 5 times higher than same dose given

orally.

- Parenteral benzodiazepines should not be administered

until at least 1 hour after IM olanzapine administration

IM Onset 15 to 45 mins

Peak 15 to 45 mins

Half-life 30 hrs

Promethazine IM Onset 20 mins

Peak 2 to 8 hrs

Half-life 7 to14 hrs

- Prolonged

sedation

- Seizures

-

Cardiorespirat

ory

depression

- It is an antihistamine that is derived from

phenothiazines.

- Phenothiazines can cause QT interval elongation

therefore a baseline ECG measurement would be

recommended as good practice prior to administration

- Use of IM promethazine for rapid tranquilisation is off-

label.

- It has a slow onset of action, but is an effective

sedative.

- Dilution is not required before IM injection.

- Smaller doses will be required in severe renal

impairment.

- Use with caution in hepatic impairment, respiratory

disease and congestive heart failure.

- As promethazine is NOT a benzodiazepine, flumazenil

is not an antidote to reverse its effects.

Midazolam IM Onset 15 mins

Peak 30 to 60 mins

Half-life

1.5to2.5hrs

- Respiratory

Depression

- Disinhibition

- Amnesia

- Use of midazolam IM for rapid tranquilisation is off-

label.

- Simultaneous injection of parenteral benzodiazepines

and IM olanzapine is not recommended due to the

potential for excessive sedation, cardiorespiratory

depression and in very rare cases, death. (Schedule 3

CD)

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Table 2: Haloperidol administration – oral and intramuscular equivalent doses

As the parenteral and oral bioavailability differ, the maximum daily dose for both

routes are not the same

Maximum dose in 24 hours :

Haloperidol Oral 20mg

Haloperidol IM 12mg

Please use the conversion chart below, if a patient has received both haloperidol IM and oral

in the last 24 hours, to calculate how much the patient has received in total:

Approximate Equivalent Doses of Haloperidol (mg)

Oral 0.5 1 1.5 2.5 4.2 5 7.5 8.3 10 12.5 16.7

IM 0.3 0.6 0.9 1.5 2.5 3 4.5 5 6 7.5 10

For example:

Patient has been given 1 x 4mg haloperidol IM, followed 30 minutes later by 5mg orally, then

30 minutes later by another 5mg orally.

Convert to all oral doses, i.e. 6.6mg + 5mg + 5mg = 16.6mg oral equivalent or

Convert to all IM doses, i.e. 4mg + 3mg + 3mg = 10mg IM equivalent

Therefore the patient may receive a further 3mg oral equivalent or 2mg IM equivalent

haloperidol within the 24 hour period.

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3.1 Rapid Tranquilisation for 18-65 years

This algorithm should be used in conjunction with the Rapid Tranquilisation Policy – it is not

a stand-alone Algorithm.

For known patients or patients under the influence of alcohol or illicit substances use lower

end of doses range. If known patients consider what has worked before.

Consider this route for

patients with:

Epilepsy/seizure

disorder

Older people –

organic disorder

TIA/CVA/CVD

Pregnancy

Narrow angle

glaucoma

Non-urgent tranquilisation

Offer oral therapy

Lorazepam 2-4mg

(with or without Haloperidol 5mg)

OR Olanzapine 10mg

Lorazepam IM 1 to 4mg

(dilute 50:50 with water for

injection)

AND/OR

Haloperidol IM 5mg

Wait 1 hour

If successful continue or

initiate oral therapy

If unsuccessful, refuses oral therapy or urgent

rapid tranquilisation


patients with:

Previous dystonic reaction

to antipsychotics

1st episode/ neuroleptic

naïve

Bipolar Affective

Disorder – sensitive to

extrapyramidal side

effects

Not suitable for patients

with:

Liver impairment

CVD/TIA/CVA/ pervious

stroke

Lorazepam IM 1 to 4mg


injection)

OR

Olanzapine IM 10mg

*For 60+ patients use over

65 chart

Consider Mental Health Act status before

and during use of Rapid Tranquilisation

Regular medicines continue throughout, where

possible and appropriate to do so.

Maximum doses (BNF limits)

Max of 4mg Lorazepam PO/IM in

24 hours

If on regular haloperidol max 20mg

PO/ 12mg IM in 24 hours

If on regular Olanzapine max dose

of 20mg / 24 hours ( in max 3

injections)

Repeat up to the BNF limits

Dose based on initial

response Lorazepam IM

(max 4mg/24hrs)

AND/OR

Haloperidol IM (Max 12mg/

24hrs) Wait at least 1 hour

Alternate Olanzapine &

Lorazepam

Maximum doses in 24 hours

Lorazepam up to 4mg (do not

repeat within 1 hour of

previous Olanzapine IM)

Olanzapine up to 20mg in

max 3 injections (do not

repeat within 2 hours of


Have available

Procyclidine PO/IM for acute dystonic

reactions – 5mg three times a day

Flumazanil IV for benzodiazepine induced

respiratory depression

Do not mix any drugs in the same syringe

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3.2 Rapid Tranquilisation for over 65 years





Avoid use of antipsychotics if patient has a dementing illness

DONOT USE ANTIPSYCHOTIC FOR PATIENTS WHO MAY HAVE LEWY BODY

DEMENTIA OR PARKINSONS DISEASE


patients with:

Epilepsy/seizure disorder

organic disorder

TIA/CVA/CVD

Narrow angle glaucoma


Offer oral therapy

Lorazepam 500micrograms to 2mg

Lorazepam IM

500micrograms to 2mg


injection)

AND/OR

Haloperidol IM 2.5mg

Wait 1 hour






patients with:


to antipsychotics


naïve

Bipolar Affective


extrapyramidal side

effects


with:

Liver impairment


stroke

Lorazepam IM

500micrograms to 2mg


injection)

OR

Olanzapine IM 2.5-5mg

Lorazepam IM 500micrograms to 2mg

(Dilute 50:50 with water for injection)





24 hours




of 20mg / 24 hours ( in max 3

injections)



response Lorazepam IM

(max 2mg/24hrs)

AND/OR


24hrs)

Wait at least 1 hour

Alternate Olanzapine &

Lorazepam


Lorazepam up to 2mg (do not







Have available






If unsuccessful but accepting

oral therapy offer

Haloperidol 500micrograms

to 1.5mg OR Olanzapine

2.5mg



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3.3 Rapid Tranquilisation for 18-65 years when Lorazepam IM Unavailable






patients with:

Epilepsy/seizure

disorder

Older people –

organic disorder

TIA/CVA/CVD

Pregnancy

Narrow angle

glaucoma


Offer oral therapy

Lorazepam 2-4mg

(with or without Haloperidol 5mg)

OR Olanzapine 10mg

Promethazine IM 25 to 50mg

(if Promethazine IM is

unsuitable consider

Midazolam IM 5 to 7.5mg)

AND/OR

Haloperidol IM 5mg

Wait 1 hour






patients with:


to antipsychotics


naïve

Bipolar Affective


extrapyramidal side

effects


with:

Liver impairment


stroke

Promethazine IM 25 to

50mg (if Promethazine IM

is unsuitable consider

Midazolam IM 5 to 7.5mg)

OR

Olanzapine IM 10mg

*For 60+ patients use over

65 chart







24 hours

Max of 100mg Promethazine IM in

24 hours

(Midazolam IM max 15mg in 24

hours)




of 20mg / 24 hours PO/IM

combined ( in max 3 injections)



response Promethazine IM

(max 100mg/24hrs)

(Midazolam IM max

15mg/day)

AND/OR


24hrs)


Repeat up to BNF limits


Promethazine 100mg

(Midazolam 15mg, do not






previous Olanzapine IM

Have available






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3.4 Rapid Tranquilisation for over 65 years when Lorazepam IM Unavailable





Avoid using antipsychotics if patient has a dementing illness

DO NOT USE ANTIPSYCHOTICS FOR PATIENTS WHO MAY HAVE LEWY BODY

DEMENTIA OR PARKINSONS DISEASE


patients with:

Epilepsy/seizure

disorder

Older people –

organic disorder

TIA/CVA/CVD

Narrow angle

glaucoma


Offer oral therapy

Lorazepam 500micrograms - 2mg

Promethazine IM 12.5 to

25mg (if Promethazine IM is

unsuitable consider

Midazolam IM 2.5 to 5mg)

AND/OR

Haloperidol IM 2.5mg

Wait 1 hour






patients with:


to antipsychotics


naïve

Bipolar Affective


extrapyramidal side

effects


with:

Liver impairment


stroke

Promethazine IM 12.5 to

25mg (if Promethazine IM

is unsuitable consider

Midazolam IM 2.5 to 5mg)

OR

Olanzapine IM 2.5-5mg





24 hours

Max of 50mg Promethazine IM in

24 hours

(Midazolam IM max 7.5mg in 24

hours)




of 15mg / 24 hours PO/IM

combined ( in max 3 injections)



response Promethazine IM

(max 50mg/24hrs)

(Midazolam IM max

7.5mg/day)

AND/OR


24hrs)


Repeat up to BNF limits


Promethazine 50mg

(Midazolam 7.5mg, do not







Have available








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4.0 Monitoring

A number of adverse effects are associated with the medicines used in RT including,

extrapyramidal side effects (EPSE), respiratory depression, seizures, over-sedation or loss of

consciousness, hypotension and neuroleptic malignant syndrome. Of particular concern, is the

possibility of sudden cardiac death and arrhythmias. After RT is administered, nursing staff

should monitor physical observations on the VitalPAC system. Prescribers should be aware of

actions to be taken if a patient’s physical condition deteriorates as a result of RT (see remedial

measures in Rapid Tranquilisation). If a patient is unconscious then close observation of

physical well-being with 1:1 nursing is recommended.

5.0 Assessment

If rapid tranquilisation is used then an Airway, Breathing, Circulation, Disability, (ABCD)

approach to assess and treat the patient should be used. If possible the patient should be

reviewed by a senior doctor such as at year 2 senior house officer, registrar or consultant to

assess the patient for monitoring, administration of reversal agents and need for critical care.

A senior review should also be sought if the intervention does not work and a second

intervention is required. As soon as possible a capacity assessment/DoLS (linking into the

Mental Capacity Policy) or a mental health assessment may be required as well as a best

interests meeting if enforced medication will continue to be required.

6.0 Remedial measures in Rapid Tranquilisation

Problem Remedial Measure

Acute Dystonia (including

oculogyric crisis)

Give intramuscular (IM) procyclidine 5-10mg

Reduced Oxygen saturation (less than 90%) or respiratory

rate (less than 10 breaths/

minute)

Give oxygen; raise legs, ensure patient is not lying face down

Give 200micrograms intravenously over 30 seconds of flumazenil

if benzodiazepine-induced respiratory depression suspected. A

further dose of 300 micrograms can be given if no response after 30

seconds. Consult BNF for further management

Irregular or slow (50bpm)

pulse or drop in blood pressure

(more than 30mmHg diastolic)

Lie patient flat, tilt bed towards head or raise legs on pillows.

Monitor blood pressure closely

Policy written using the following resources:

Cheshire and Wirral Partnership NHS Foundation Trust. Rapid Tranquilisation (RT) Policy.

Issue Number 8 September 2014. Available at http://www.cwp.nhs.uk/

Oxford University Hospitals NHS Foundation Trust. Management of Acutely Disturbed

Behaviour for adults (including Rapid Tranquilisation). Volume 9, Number 6. September

2015

National Institute for Health and Clinical Excellence (NICE) (2015) Violence and aggression:

short-term management in mental health, health and community settings. [Online]. Available

at: https://www.nice.org.uk/guidance/ng10. [Accessed: 15 January 2016].

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Equality Analysis (Impact assessment)

1. What is being assessed?

Rapid Tranquilisation Policy for Adult Patients within East Cheshire NHS Trust

Details of person responsible for completing the assessment:

Name: Kashif Haque

Position: Chief Pharmacist

Team/service: Pharmacy

State main purpose or aim of the policy, procedure, proposal, strategy or service:

(usually the first paragraph of what you are writing. Also include details of legislation,

guidance, regulations etc which have shaped or informed the document)

Agitated and aggressive behaviour from patients is common. Such behaviours increase the risk of harm to

the patient themselves, other patients, and hospital staff. The clinical practice of restraint and, or rapid

tranquilisation is used when psychological and behavioural approaches have failed to deescalate acutely

disturbed behaviour. It is essentially a management strategy of last resort.

2. Consideration of Data and Research To carry out the equality analysis you will need to consider information about the people who

use the service and the staff that provide it

2.1 Give details of RELEVANT information available that gives you an understanding

of who will be affected by this document

Cheshire East (CE) covers Eastern Cheshire CCG and South Cheshire CCG. Cheshire West &

Chester (CWAC) covers Vale Royal CCG and Cheshire West CCG. In 2011, 370,100 people

resided in CE and 329,608 people resided in CWAC.

Age: East Cheshire and South Cheshire CCG’s serve a predominantly older population than the

national average, with 19.3% aged over 65 (71,400 people) and 2.6% aged over 85 (9,700

people).

Vale Royal CCGs registered population in general has a younger age profile compared to the

CWAC average, with 14% aged over 65 (14,561 people) and 2% aged over 85 (2,111 people).

Since the 2001 census the number of over 65s has increased by 26% compared with 20%

nationally. The number of over 85s has increased by 35% compared with 24% nationally.

Race:

In 2011, 93.6% of CE residents, and 94.7% of CWAC residents were White British

5.1% of CE residents, and 4.9% of CWAC residents were born outside the UK – Poland

and India being the most common

3% of CE households have members for whom English is not the main language (11,103

people) and 1.2% of CWAC households have no people for whom English is their main

language.

Gypsies & travellers – estimated 18,600 in England in 2011.

Gender: In 2011, c. 49% of the population in both CE and CWAC were male and 51%

female. For CE, the assumption from national figures is that 20 per 100,000 are likely to be

transgender and for CWAC 1,500 transgender people will be living in the CWAC area.

14

Disability:

In 2011, 7.9% of the population in CE and 8.7% in CWAC had a long term health

problem or disability

In CE, there are c.4500 people aged 65+ with dementia, and c.1430 aged 65+ with

dementia in CWAC. 1 in 20 people over 65 has a form of dementia

Over 10 million (c. 1 in 6) people in the UK have a degree of hearing impairment or

deafness.

C. 2 million people in the UK have visual impairment, of these around 365,000 are

registered as blind or partially sighted.

In CE, it is estimated that around 7000 people have learning disabilities and 6500 people

in CWAC.

Mental health – 1 in 4 will have mental health problems at some time in their lives.

Sexual Orientation:

CE - In 2011, the lesbian, gay, bisexual and transgender (LGBT) population in CE

was estimated at18,700, based on assumptions that 5-7% of the population are likely

to be lesbian, gay or bisexual and 20 per 100,000 are likely to be transgender (The

Lesbian & Gay Foundation).

CWAC - In 2011, the LGBT population in CWAC is unknown, but in 2010 there

were c. 20,000 LGB people in the area and as many as 1,500 transgender people

residing in CWAC.

Religion/Belief:

The proportion of CE people classing themselves as Christian has fallen from 80.3% in 2001

to 68.9% In 2011 and in CWAC a similar picture from 80.7% to 70.1%, the proportion saying

they had no religion doubled in both areas from around 11%-22%.

Christian: 68.9% of Cheshire East and 70.1% of Cheshire West & Chester

Sikh: 0.07% of Cheshire East and 0.1% of Cheshire West & Chester

Buddhist: 0.24% of Cheshire East and 0.2% of Cheshire West & Chester

Hindu: 0.36% of Cheshire East and 0.2% of Cheshire West & Chester

Jewish: 0.16% of Cheshire East and 0.1% of Cheshire West & Chester

Muslim: 0.66% of Cheshire East and 0.5% of Cheshire West & Chester

Other: 0.29% of Cheshire East and 0.3% of Cheshire West & Chester

None: 22.69%of Cheshire East and 22.0% of Cheshire West & Chester

Not stated: 6.66% of Cheshire East and 6.5% of Cheshire West & Chester

Carers: In 2011, nearly 11% (40,000) of the population in CE are unpaid carers and just

over 11% (37,000) of the population in CWAC.

2.2 Evidence of complaints on grounds of discrimination: (Are there any complaints or

concerns raised either from patients or staff (grievance) relating to the policy, procedure,

proposal, strategy or service or its effects on different groups?)

No

2.3 Does the information gathered from 2.1 – 2.3 indicate any negative impact as a

result of this document?

No

15

3. Assessment of Impact

Now that you have looked at the purpose, etc. of the policy, procedure, proposal, strategy

or service (part 1) and looked at the data and research you have (part 2), this section asks you

to assess the impact of the policy, procedure, proposal, strategy or service on each of the

strands listed below.

RACE:

From the evidence available does the policy, procedure, proposal, strategy or service

affect, or have the potential to affect, racial groups differently? Yes

Explain your response: If there is a patient whose first language is not English, then staff

need to be aware of how to access interpretation facilities.

___________________________________________________________________________

_________

GENDER (INCLUDING TRANSGENDER):


affect, or have the potential to affect, different gender groups differently? No

Explain your response: If the patient takes medication as part of the transgender process,

staff would check with pharmacy for any interaction.

DISABILITY


affect, or have the potential to affect, disabled people differently? Yes

Explain your response: When providing information, the Trust is required to provide it in a

format that is relevant to the applicant’s and this that could mean in audio/braille for the

visually impaired for example.

___________________________________________________________________________

_________

AGE:

From the evidence available does the policy, procedure, proposal, strategy or service,

affect, or have the potential to affect, age groups differently? Yes

Explain your response: Policy applies equally regardless of age, however, staff need to be

mindful that older people can be more vulnerable and therefore more at risk.

LESBIAN, GAY, BISEXUAL:


affect, or have the potential to affect, lesbian, gay or bisexual groups differently? No

Explain your response: Policy applies equally regardless of sexuality

___________________________________________________________________________

_________

RELIGION/BELIEF:


affect, or have the potential to affect, religious belief groups differently? No

16

Explain your response: If the patient is unable to consume vertain substances due to their

religion/belief, staff would check with pharmacy for any interaction.

___________________________________________________________________________

__________

CARERS:


affect, or have the potential to affect, carers differently? No

Explain your response: Carers would be kept informed as appropriate.

___________________________________________________________________________

__________

OTHER: EG Pregnant women, people in civil partnerships, human rights issues.


affect, or have the potential to affect any other groups differently? Yes

Explain your response: The choice of drug used may be affected if the patient is either

pregnant or breast feeding. Specialist advice from the medivines information centre should be

sought.

-

___________________________________________________________________________

__________

4. Safeguarding Assessment - CHILDREN a. Is there a direct or indirect impact upon children No

b. If yes please describe the nature and level of the impact (consideration to be given to all

children; children in a specific group or area, or individual children. As well as consideration of

impact now or in the future; competing / conflicting impact between different groups of children

and young people:

c. If no please describe why there is considered to be no impact / significant impact on children

Policy applies to adults only

5. Relevant consultation Having identified key groups, how have you consulted with them to find out their views and

that the made sure that the policy, procedure, proposal, strategy or service will affect them

in the way that you intend? Have you spoken to staff groups, charities, national organisations

etc?

Staff groups and national data and recommendations for safeguarding taken into account.

6. Date completed: 05.09.2016 Review Date: Sept 2018

7. Any actions identified: Have you identified any work which you will need to do

in the future to ensure that the document has no adverse impact?

Action Lead Date to be Achieved

8. Approval – At this point, you should forward the template to the Trust Equality

and Diversity Lead [email protected]

Approved by Trust Equality and Diversity Lead: Date: 7.9.16

mailto:[email protected]

Rapid Tranquilisation Policy for Adult Patients within ... · 2 Policy Title: Rapid Tranquilisation...

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