Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: de-escalation and rapid tranquillisation

Maxine X Patel, Faisil N Sethi, Thomas RE Barnes, Roland Dix, Luiz Dratcu, Bernard Fox, Marina Garriga, Julie C Haste, Kai G Kahl, Anne Lingford-Hughes, Hamish McAllister-Williams, Aileen O'Brien, Caroline Parker, Brodie Paterson, Carol Paton, Sotiris Posporelis, David M Taylor, Eduard Vieta, Birgit Vollm, Charlotte Wilson-Jones, Laura Woods
  • Journal of Psychiatric Intensive Care, January 2018, NAPICU (National Association of Psychiatric Intensive Care Units)
  • DOI: 10.20299/jpi.2018.008

Clinical Guideline in Managing Acute Disturbance

What is it about?

Recommendations for clinical practice and an algorithm to guide treatment by healthcare professionals with various options outlined according to their route of administration and category of evidence. There is a focus on three key interventions: de-escalation, pharmacological interventions pre-rapid tranquillisation and rapid tranquillisation (intramuscular and intravenous).

Why is it important?

The management of acute disturbance is a complex process. The interplay of both pharmacological and non-pharmacological interventions, including de-escalation, is important. We advocate that the clinician can determine the optimal evidence-based interventions centred within a multidisciplinary approach, which also includes an individualised patient perspective.


Dr Faisil N Sethi (Author)
South London and Maudsley NHS Foundation Trust

We hope this guideline heralds a step-change in the way we manage agitation in health settings. Quality, safety and patient experience should be the foundation of all interventions in healthcare.

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The following have contributed to this page: Dr Faisil N Sethi