A patient on the psychiatric ward becomes acutely agitated and aggressive, threatening staff. De-escalation has been attempted but has failed. What do you do?

Tips to guide your answer

- NICE NG10 is the key guideline for managing violence and aggression

- De-escalation should always be attempted first - verbal and non-verbal techniques

- If de-escalation fails, consider physical restraint and/or rapid tranquillisation (RT)

- RT medication options (NICE NG10): IM lorazepam alone, OR IM haloperidol combined with IM promethazine

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How to approach this Psychiatry interview question

This quality improvement question is common in Psychiatry NHS interviews because it reveals how you think under interview pressure, not just what facts you can recall. Use "A patient on the psychiatric ward becomes acutely agitated and aggressive, threatening..." as the anchor for a concise answer with a clear opening, a clinical or professional structure, and a reflective close.

What the panel is testing

A strong quality-improvement answer uses method as well as enthusiasm. Be clear about the problem, baseline measurement, intervention, re-measurement, and how the change was made sustainable. For psychiatry, risk assessment, capacity, legislation, rapport, and multidisciplinary planning are usually central. Keep the answer humane, structured, and legally aware.

Separate audit, QI, research, and clinical governance clearly so the panel can follow your reasoning.
Use a real cycle: baseline, intervention, re-measurement, learning, and sustainability.
Link the project back to patient safety, service reliability, or measurable outcomes.

How to structure your answer

For a quality improvement prompt, aim for a short opening sentence, then two or three evidence-led points, then a final reflection. If you use STAR, keep the result and reflection as strong as the situation. If it is a clinical scenario, say what you would do now, what you would do next, and how you would keep the patient safe while help is coming.

Open by naming the main issue in the question.
Give a structured response rather than a memorised script.
End with escalation, documentation, learning, or follow-up.

Common mistakes to avoid

The weakest answers usually stay too vague, ignore the specific role, or miss the safety issue hidden in the question. Do not use this page to memorise a perfect paragraph. Use it to rehearse the shape of a safe answer, then adapt it to your own experience and the post you are applying for.

NICE NG10 is the key guideline for managing violence and aggression
De-escalation should always be attempted first - verbal and non-verbal techniques
If de-escalation fails, consider physical restraint and/or rapid tranquillisation (RT)