Carl Heneghan

Yeah, I'm really sorry.

Signed NICE.

I'm sorry.

I apologise.

You need like a little bell or a... Scottish Intercollegiate Guideline Network.

National Institute of Clinical Excellence.

So there's slightly in social care.

Something else is in there, but that's NICE.

Their recommendation 1.6.4 basically says that actually you could use haloperidol in people for up to a week if... I need my phone.

Sorry about this.

I need to be exact when it comes to knife or I'll get critted.

Is that all right?

The National Institute of Clinical Excellence, that's nice for sure, says in recommendation 1.6.4, if a person with delirium is distressed or considered a risk to themselves or others, and verbal and non-verbal de-escalation techniques are ineffective or inappropriate, consider giving short-term, usually for one week or less, haloperidol.

Start the lowest clinically appropriate dose and titrate cautiously according to symptoms.

Now, what I'm saying is, number one, is there's no evidence for that.

Number two is there is evidence for the non-drug interventions, but they're labour intensive and difficult to deliver.

And in a hospital environment where there often is a shortage of nurses, doctors,

people are not going to use the verbal and non-verbal de-escalation techniques.

Then there'll be a potential for people to use the haloperidol.

And the problem here is, if you are going to do this, you have to have on the drug chart at one week it's struck off because what concerns me is people just get left on the treatment.