SAQ 429 – Administration – emergency department chemical restraint protocol
Model Answer
Administration – emergency department chemical restraint protocol.
a. Stakeholders
- Emergency medicine medical staff.
- Emergency nursing staff.
- Mental health service.
- Pharmacy.
- Security.
- General medicine or aged care.
- Toxicology, paediatrics/adolescent medicine, or consumer/patient representative as locally relevant.
b. Protocol elements
- Title, purpose, and scope.
- Who must comply and where the protocol applies.
- Background, indications, contraindications, and precautions.
- Required equipment, staffing, monitoring, and observation frequency.
- Stepwise procedure including de-escalation, drug choice, dosing, review, and escalation.
- Documentation requirements, consent/capacity considerations, and adverse-event reporting.
- Governance: author, approval body, version control, review date, and audit process.
c. Example medications
| Drug | Dose | Route |
|---|---|---|
| Droperidol | 5-10 mg | IM or IV, titrated to effect according to local policy. |
| Midazolam | 2.5-5 mg IV or 5-10 mg IM | IV or IM, with respiratory monitoring. |
| Olanzapine | 5-10 mg | Oral/ODT or IM; avoid close parenteral benzodiazepine co-administration unless locally approved. |
| Ketamine | 4-5 mg/kg IM | IM for severe excited delirium or immediate danger where local policy supports it. |
d. Indications
- Immediate risk of harm to the patient, staff, other patients, or property.
- De-escalation has failed or is unsafe to attempt.
- Essential assessment or treatment cannot proceed safely without sedation.
- Severe agitation due to mental illness, delirium, intoxication, or organic disease with impaired capacity.
- Legal authority or duty of care supports urgent treatment in the patient's best interests.
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