A cross-sectional clinical audit of rapid tranquillisation practices for elderly patients at Surrey and Sussex Healthcare NHS trust

Abstract

Introduction: Rapid tranquillisation (RT) is a procedure that is often used in hospitals for confused, agitated, aggressive or violent patients. RT is most commonly used with the elderly, often suffering from delirium or dementia. The goal is to sedate the patient, thus minimising the risk of harm to themselves or others. The procedure in East Surrey Hospital (ESH) (locus of this audit) is governed by Surrey and Sussex Hospital Trust (SASH), as the medications used may require careful selection according to various factors. The aim of this audit was to explore the extent to which SASH adheres to its published RT Policy, specifically concerning the RT of elderly patients (aged 75 and above). Method: The study was a cross-sectional retrospective clinical audit. The inclusion criteria were that the patients were to be aged 75 or older, have received RT at ESH between 1st May 2023 and 14th June 2023. The data were analysed using SPSS software, Version 28. Findings: Overall, an 84% adherence rate was achieved for the 14 standards that were applied. The rate of non-adherence ranged from 0% to 100%. Eight of the standards were met with 100% adherence; one standard and three standards achieved adherence rates between 90 and 99% and between 80 and 89%, respectively; one standard had an adherence rate of 30%; and one standard achieved an adherence rate of 0%. For 25%, 44.7% and 14.9% of the patients, 13, 12 and 11 standards were met, respectively, At least 12 of the 14 standards were met in over 85% of cases. In terms of adherence by the medical and surgical wards, for nine standards, the adherence rates were either identical or very similar; for three standards, the medical wards showed higher compliance; and for one standard, the surgical wards showed a higher rate of adherence. Thus, overall, the two kinds of wards showed very similar levels of adherence. Discussion: The audit was a valuable tool, with significant results that need to be further explored. It was suggested that adherence may have been negatively affected by work overload, the need for training or the clinical situation that presented itself. Five recommendations were made: (1) The findings should be presented to and discussed with the care team; (2) staff should be given training regarding the guidelines; (3) the clinical audit should be repeated annually; (4) an RT care plan should be published, and a computerised system installed to provide alerts when non-adherence occurs; (5) audits should be conducted at different times of the year, When hospital busyness varies. Future research may include longitudinal and qualitative studies. The clinical audit should form part of a hospital’s continuous improvement programme.