Event sequencing of forced intramuscular medication in England

In many countries staff are allowed to inject psychiatric inpatients against their will with psychotropic medication. • This study, conducted in England, found such injections were given to 9% of patients, usually in response to aggressive behaviour or medication refusal. • In most cases the forced injections ended a crisis, but the study concludes that there are opportunities for staff to use alternative approaches. In most inpatient psychiatric care systems it is permissible in certain situations for staff to forcibly inject patients with psychotropic medication. The aim of this study is to describe what precedes and follows a coerced intramuscular injection within a nursing shift. Data were collected on the sequence of conflict (aggression, absconding, etc.) and containment (seclusion, restraint, etc.) for the first 2 weeks of 522 acute admissions on 84 wards in 31 UK hospitals. Injections were given to 9% of patients. Aggression, regular medication refusal and pro re nata (PRN) medication refusal preceded injections. The giving of coerced medication concluded most crises. Coerced medication effectively resolves crises in the short term. Staff should offer oral PRN as an alternative, unless this is unsafe. Where only verbal violence has occurred staff should try to resolve the crisis without enforcing medication. More research on the best way to respond to inpatients' medication refusal is required. © 2012 Blackwell Publishing.