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21 Rapidly failing, slowly tranquillising
  1. Brenda Wasunna-Smith,
  2. Ross Runciman
  1. NHS Foundation Trust, UK

Abstract

Our poster aims to discuss the evolving nature of effecting change in a mental health trust from a trainee perspective.

The problem at hand was improving the safety of administration of rapid tranquillisation (RT), whilst striving for better documentation and closer monitoring of the patient after administration.

This process of change began approximately 5 years ago when Dr Wasunna-Smith needed to administer RT for the first time and was unable to find the RT policy easily. Further investigation using baseline audit data highlighted RT in the trust varied enormously and documentation was equally variable.

The authors escalated concerns with senior pharmacist to consultant psychiatry colleagues. An RT committee was formed to assess current practice, policy, NICE guideline NG10 and write a new RT policy.

Multiple interventions resulted from implementing the policy: drug cards were re-written, a post-RT physical monitoring protocol and a training package developed for clinical colleagues.

The key to our approach was developing a training package designed and delivered by and to doctors and nurses. With our joint training we are starting to see a cultural change in the way RT occurs, from inception through to aftercare. Measuring this kind of change is difficult.

Lessons include the importance of recognising the critical issue from the start – in this case the culture in which RT is administered. In addition, the importance of having key stakeholders involved from the start and how to influence trust structures.

The role of the junior doctor in change is varied; being the advocate for an issue and finding ways to stick with it over many years is important but challenging. There are often obstacles but this is in itself vital training in communication and negotiation of complex bureaucracies.

The impact of change on patients for this project is giving greater assurance that RT is used in the safest manner possible with appropriate aftercare.

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