New psychotropic standard
The clinical care standard includes eight quality statements describing safe and appropriate care and a set of indicators to support monitoring and quality improvement.
The Australian Commission on Safety and Quality in Health Care has published a national medicines standard that aims to curb the inappropriate use of psychotropic medicines among people with dementia and other cognitive impairments or disability.
The Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard outlines actions to ensure the responsible and appropriate use of psychotropic medicines and safer, more effective treatment practices.
In the aged care sector alone 61 per cent of residents are given at least one psychotropic medicine in their first three months in a home while older people with dementia are two times more likely to be prescribed an antipsychotic than older people without the diagnosis.
The clinical care standard – launched during a webcast on Thursday – includes eight quality statements describing safe and appropriate care starting with person-centred care and a set of indicators to support monitoring and quality improvement.
It highlights the importance of individualised non-medication interventions as the primary method for addressing behaviours of concern, with psychotropic medicines reserved as a last resort option when other strategies have failed, or there is a high risk of harm to the person or others.
Associate Professor Juanita Breen – a credentialled pharmacist specialising in dementia research at the University of Tasmania – said monitoring and evaluating prescribing practices was key.
“Clinicians and doctors should regularly review medicines to ensure their effectiveness and be mindful of potential side effects. We should always be asking: Could this medicine dose be reduced? Can we improve these symptoms through non-medicine approaches?”
The new standard comes after the Royal Commission into Aged Care Quality and Safety and its counterpart for people with a disability revealed concerning trends in psychotropic medicines misuse and overuse in the aged care and disability sectors.
While they play an important role in treating mental health conditions, psychotropic medicines are commonly used to manage behaviours of concern despite the known harms and lack of evidence they are effective for managing behaviours including aggression, agitation, and sometimes self-harm.
Antipsychotic use comes with a 22 per cent higher risk of death in the first 100 days in residential aged care. For older people with dementia, some psychotropics can increase the risk of stroke, pneumonia, falls and death.
In March 2022, the ACSQHC, the Aged Care Quality and Safety Commission and the NDIS Quality and Safeguards Commission released a joint statement on the inappropriate use of psychotropics to manage the behaviours of people with disability and older people and the detrimental impact it had. The release of this standard joins other efforts to improve the safety and quality of health care, aged care and disability support for all Australians, the commission said in a statement.
Today’s release includes a 100-page document on the clinical standard, 24-page easy-read version, communications kit and other resources.
The standard applies to all healthcare services provided to people of all ages with cognitive disability or impairment and is relevant in any setting where they receive care, including hospitals, aged care facilities and the community. It has been endorsed by 25 key professional associations and consumer organisations.
It highlights that non-medication strategies should be designed around the person’s individual needs and expressed wishes, and in consultation with family and others the person has agreed should be involved in their care.
Conjoint Associate Professor Carolyn Hullick, Chief Medical Officer at the Commission and Emergency Physician in Hunter New England Health NSW called the standard a long-overdue recognition of the rights of people with cognitive impairment to safe and effective treatment options.
“From my perspective, I think it’s essential for prescribers and clinicians to be mindful of the way they’re using psychotropic medicines because of their risks and limited benefits for people with behaviours of concern,” she said. “Psychotropic medicines do have a place, but it is imperative that we use them judiciously and with a clear understanding of their purpose.”
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