Rapid tranquillisation on mental health wards is much-debated.
On the one hand, rapid tranquillisation is sometimes needed to maintain the safety of the ward, on the other hand it carries with it extreme risks to the patient, can be addictive and arguably should be the last resort when all other methods of de-escalation have failed.
Patients are often subscribed tranquillising and antipsychotic drugs PRN so they can approach staff if they feel they need additional medication. In my experience, this can work well with patients being afforded the opportunity to take responsibility of controlling their symptoms before escalating.
However, as a staff nurse what do you do if a patient asks for medication they do not appear to need?
As you can’t tell what’s happening in someone’s mind, should you take their word for it that they know what they need?
What if they have been sitting watching TV, appearing calm for the past hour, and strolled to the nursing station to request highly-addictive benzodiazepines?
Giving medication without clinical need is not in the patient’s best interest and may in fact be feeding an addiction.
But, what if saying “no” leads to aggressive behaviour, putting patients, staff, visitors and the hospital environment at risk?
I have witnessed patients requesting lorazepam without clinical need only to be, rightly, refused this by nursing staff. In order to ensure they got the medication they wanted, I’ve seen patients then damage hospital property, threaten staff and other patients and escalate to the point that staff have no choice but to medicate in order to maintain the safety of the ward.
This positive reinforcement of disruptive behaviour only leads to the same happening again.
Benzodiazepines are all too often given without consideration to the long-term consequences. The MDT must look at ways to balance the short-term benefits of using these drugs with the long-term affect they may have on the patient and the nature of their care.
What do you think? Do we give out too many benzodiazepines without considering the consequences of long-term addiction? Are we too quick to use rapid tranquillisation to de-escalate?