Behaviours that Challenge in acute care: Rethinking psychological support and the use of sedatives

Vollständiger Abstract

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Chemical restraint is a term often associated with discomfort, unease and ethical uncertainty. It suggests a moment where a person’s autonomy is overridden, where distress is interpreted through the lens of risk and where medication replaces understanding. Yet in acute medical settings, particularly emergency departments, assessment units, and frailty wards, situations arise in which sedative medication is used. This is rarely due to careless or poorly informed clinicians; rather, it reflects the environment itself (high levels of urgency, rapidly escalating medical needs, limited staffing, and the need to make swift decisions to protect a patient’s safety during acute deterioration). Chemical restraint fails to meet the needs of older adults experiencing delirium, dementia, or other cognitive difficulties, because sedation does not address the underlying unmet needs causing distress. Guidelines assume calm spaces, time for person-centred care and opportunities to trial several non-pharmacological approaches before trying medication. Acute medicine offers none of these conditions. Our recent series of audits across South Warwickshire University NHS Foundation Trust (SWFT) explored the use of chemical restraint in response to behaviours of unmet needs.