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Prescribing of psychotropics a shared responsibility, inquiry told


Residential aged care providers and the family of residents should also be accountable for any psychotropic medications prescribed, a leading dementia expert tells the royal commission.

Professor Henry Brodaty, Scientia Professor at the Centre for Health Brain Ageing at the University of New South Wales, told the aged care royal commission on Friday that current practice required general practitioners to obtain consent from a family member of a resident with dementia before prescribing a psychotropic medication.

Professor Brodaty told the inquiry that this often occurred by the GP requesting staff to ask a family member to sign a consent form on their next visit.

“If the doctor is prescribing, the doctor needs to be certain consent has been provided for that,” Professor Brodaty said. “The initial responsibility is with the doctor.”

However, aged care facilities and their staff should also hold responsibility for prescriptions, Professor Brodaty said.

“The person who’s actually giving out the medication, it would be advisable if there was some easy way for them to say that this documentation had been provided. So, the nursing home itself I think bears some responsibility as well.”

The family also has a responsibility to question why the medication was prescribed, he said.

“Often families just leave it to the doctors or nurses to say ‘well, so-and-so needs this’ rather than questioning why,” Professor Brodaty said. “It’s a bit simplistic to put it all on the doctor, although I think the doctor is the primary person in this chain.”

The dignity of risk

Professor Brodaty said aged care providers needed to better balance quality of life with duty of care.

He told the inquiry about an aged resident with Parkinson’s disease and moderate dementia who enjoyed going on walks, and often across the road.

“Because of his Parkinson’s disease, he would sometimes freeze and if he’s in the middle of the road that’s obviously dangerous. So the nursing home said he’s not allowed to go out, and he became quite agitated,” Professor Brodaty.

The wife of the resident told the facility she was happy for him to walk around and take the risk because his quality of life was more important than his safety, he said.

The provider told her “we respect that but it’s our reputation. If he gets hit by a car, we bear the responsibility. It will be all over the… media and that’s very bad for the nursing home,” Professor Brodaty said.

“I understand both points of view. The nursing home does have what they call a duty of care and responsibility, but there’s this… tension between cotton wool, safety, autonomy and independence,” he said.

Achieving quality

Elsewhere Professor Brodaty said residents, rather than profit, needed to be a provider’s top priority in order for them to deliver quality person-centred care.

“The top management needs to embrace this as a philosophy for their nursing home… that needs to come from top management but also the director of nursing homes needs to say this is our philosophy, that really the person is our first priority. It’s not about profit,”  he said.

“It’s trying to make their life as good as possible, the people living there, and for most people going to nursing homes this is their home and this is their final home.”

The Royal Commission into Aged Care Quality and Safety hearing in Sydney wrapped up today. The next hearing takes place from 17-19 June in Broome and 24-28 June in Perth. It will focus on aged care of indigenous Australians, person-centred care and the delivery of aged care in remote locations.

To stay up to date on the latest about the Royal Commission into Aged Care and Quality go to our special coverage. We will also be issuing regular Royal Commission Roundup reports which you’ll receive in addition to your weekly e-newsletters.

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5 Responses to Prescribing of psychotropics a shared responsibility, inquiry told

  1. Anton Hutchinson May 18, 2019 at 6:36 am #

    There is another issue, in our facility we have a resident with dementia and an intricate catheter. Our resident is confused and often aggressive and his son won’t allow medical intervention and then complains endlessly because his father can’t be showered due to his violent behaviour.
    Our staff are not obliged to accept being punched and pinched because of a family member failure. The resident refuses to bathe on most occasions and in the end it is his right but it contradicts our duty of care.
    Being unmedicated for this resident is not in his best interest but what do we do?

  2. Alexander Wong May 22, 2019 at 12:26 pm #

    Every party plays an important role on the challenge of decreasing psychotropic use.

    From prescribing, dispensing, administering and monitoring. The flow includes the GP, pharmacists and facility Staff.

    From a Quality use of Medicines perspective, quantitative (numbers) and qualitative (reasons) data is needed.

    This provides us a snapshot of the indicator and achievable goals and outcomes. Ultimately, we all come together and facilitate strategies together.

    Alexander Wong (Consultant Pharmacist)

  3. Stacey Masters May 22, 2019 at 5:09 pm #

    I am a family member and proponent of alternative approaches to responsive behaviours associated with dementia, rather than prescription of psychotropic medications.

    Anton – has your facility sought advice from the Dementia Behaviour Management Advisory Service (DBMAS) or Severe Behaviour Response Team (SBRT) or mental health service for older persons?

    The choice is not to administer psychotropic medications or do nothing. Both staff and family would likely benefit from external advice and support.

  4. Rosemary Blayney May 22, 2019 at 6:28 pm #

    Psychotropics have a place when prescribed appropriately,for people who are anxious and severely agitated for their comfort.Over use is not to be tolerated and all medical officers need to be educated.Learning management of dementia is vital for staff but it doesn’t always work. Staff need to be properly supervised and fully assessed before employed in these areas,some people are not suitable.

  5. Stacey Masters May 23, 2019 at 12:00 pm #

    Professor Brodaty could be clearer in describing the responsibilities of each of the parties in the prescription of psychotropic medications.

    1. Aged care staff are responsible for the quality of their documentation about observed behaviours, the context in which the behaviours occur, which behavioural interventions have been trialled and with what effect.

    2. Medical officers are responsible for prescribing. Prescribing should be based on appropriate charting. The medical officer should delay prescribing if there are inadequacies in nursing documentation.

    3. Professor Brodaty correctly points to a role for family members in questioning the prescription of psychotropic medications. However family members may not have access to relevant aged care documentation. To be informed by a medical officer that s/he is prescribing on the advice of aged care staff is to set up a ‘contested space’ between aged care staff and family.

    We need to stop passing the buck and put the older person front and centre. That’s what person-centred care is meant to be.

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