Psychotropic medication use evaluation and review in aged care
Baptcare understands the risks associated with antipsychotic medications and has introduced processes such as the ongoing use of the DUE (Drug Use Evaluation) tool to assist in appropriately managing areas of risk and identifying opportunities for potential improvement.
Staff play a vital role in monitoring the potential side effects of medication and in documenting and reporting signs and symptoms to the treating doctor. They also play a key role in ensuring the effectiveness of other non-drug treatments for managing behaviours of concern.
The development and implementation of new documentation provides medical staff with the required information and evidence to prompt the review of medication prescribed, consider alternative therapy, monitor adverse effects and consider review of the medication and potential withdrawal.
This study has highlighted several practice improvements, increased staff confidence in medication management and has improved outcomes for residents.
What we have now is an organisational wide approach to reviewing psychotropic medication use. We have a system embedded into our quality framework which means it's a process of regular audit and review.
The steps taken in the project were detailed in the DUE resource kit and were concerned with getting support from key stakeholders, gathering data, evaluating our current position, providing feedback and then taking what actions we could to bring prescribing patterns into line with any recommendations. The DUE process is one that requires continual review, repeated data collection and a commitment to regularly monitor and re-evaluating the use of psychotropic medication use.
Key partners of this program were the treating doctors, pharmacy service provider, the local Medication Advisory Committees, key nursing and care staff, as well as resident’s relatives.
We have been able to identify significant improvements in the prescription and management of antipsychotic medication in all our residential care facilities.
Practice changes that have contributed to the improvements and include the development of a suite of new documentation to assist with providing a consistent approach at all sites. The newly developed documentation includes:
- Behaviour Identification Chart: to identify triggers for behaviours and environmental and behavioural management strategies (instead of medication);
- Anti-psychotic use for Behavioural and Psychological Symptoms of Dementia (BPSD) Work Instruction: provides an overview of the current guidelines and best practice criteria to manage BPSD.
- Anti-psychotic Medication Register: a current snapshot overview of the residents that have a diagnosis of dementia and who have antipsychotic medication prescribed.
- Anti-psychotic use review plan: enables nursing and medical staff to document all relevant information in the one location for quick review.
There is now a requirement for nursing staff to review residents’ behaviour every six weeks during the Resident Evaluation or Resident of the Day schedule. This ensures that qualified nursing personnel are identifying potential causes for behaviour, appropriate treatment and interventions and liaising closely with medical staff.
Several of the sites have also been provided with extensive education addressing behaviour management and non-pharmacological methods of therapy, best practice use of pharmacological methods and ongoing monitoring and review of these medications.
There are many case studies where residents had been taking Risperidone for more than four years (without any review) and following the focus of this study, staff have now identified non-pharmacological interventions to manage these resident’s behaviour as a more appropriate and superior alternative to antipsychotic medication therapies.
Nursing staff through implementing our monitoring systems, have identified deterioration in physical condition and decline in general health leading to a decrease in behaviours. This has prompted staff to bring this to the attention of visiting medical staff to consider weaning off medication that is no longer required.
One gentleman with frequent falls and increased drowsiness had his medication reduced significantly, enabling increased participation in lifestyle programs and more interactions with family.
There has also been an overall reduction in the number of resident’s prescribed antipsychotic medication.
• 67% reduction in the use of psychotropic medications
• 40% improvement in compliance with therapeutic guidelines and prescribing patterns
• 100% consideration given to reversible causes being excluded
• 100% of services are doing something significantly better in regard to managing psychotropic medication use compared to 2012.
Panel member’s comments:
Inspired by media reporting on inappropriate use of psychotropic drugs for dementia residents, the age care provider undertook an organisation wide review at all site to underpin practice changes in use of these drugs. By undertaking a detailed quality improvement process, based around the NPS Better Choices, Better Health Professional guidelines and active engagement with health professionals, an updated approach to monitoring and use of all psychotropic drugs was implemented for all residents.This involves ongoing, regular reviews for all residents and identification of alternate approaches to the use of psychotropic drugs use. The project involves continuous and ongoing organisation wide commitment, and has proved to result in significant reductions (67 percent reduction) in use of these drugs and implementation of successful alternate therapies.
With psychotropic medication now being somewhat controversial, though important to be utilised in many circumstances, the applicant appears to have really “taken the bull by the horns” and implemented a well thought through and comprehensive DUE program. Benefits for all concerned are clearly demonstrated and the programme is worthy of wider implementation across all RACFs.
For more information on this program, contact Lindon Le Griffon – llegriffon@Baptcare.org.au, or phone 0439 038 570.