This paper describes the development process of a concise, portable clinical practice guideline for the medication management of acute behavioural disturbance in adult psychiatric inpatients in Auckland, New Zealand. It was developed to aid psychiatry registrars and is a decision aid only. A literature search identified evidence-based reviews and guidelines implemented elsewhere. This formed the basis for development of a locally relevant tool, finalised for implementation by a process of consensus agreement. This clinical practice guideline was developed collaboratively over 2 years in response to local need. Development was requested by junior medical staff and actively supported by clinical leaders. The guideline resulted from a review of the evidence for medication management of acute behavioural disturbance and adaptation of the UK National Institute for Clinical Excellence guidance in combination with local consensus agreement.