Standard 3 of the new Aged Care Quality Standards states that organisations must demonstrate that each consumer is provided with clinical care that is “best practice; and tailored to their needs; and optimises their health and well-being” (1).
In terms of the use of medications to support people living with dementia who demonstrate responsive behaviour, what does ‘best practice’ mean, and how can we achieve this?
Responsive behaviours are experienced by many people who are living with dementia. In many instances, non-medication approaches are overwhelmingly the most appropriate and effective means of providing support.
Australian and international clinical guidelines advise that antipsychotic medications offer limited effectiveness for responsive behaviour. Furthermore, their use is associated with a risk of serious harm and death. Medications should only be considered as a last resort when all possible non-medication approaches have failed, and only if the person living with dementia is experiencing distressing psychosis or a responsive behaviour that is harmful/severely distressing to themselves or puts others at risk. If these medications are prescribed the lowest possible dose should be used for the shortest possible time.
However, many residential aged care staff say they have difficulties in following these guidelines for a number of reasons. This, includes a lack of knowledge, a lack of confidence when communicating with prescribers, and inadequate medication management processes. As a result, potentially unnecessary use of antipsychotic medications is widespread.
The Department of Health has recently updated provider resources for the Aged Care Quality Standards to address concerns about the inappropriate use of antipsychotic medications as a form of chemical restraint.
The guidance for Standard 3 now refers to medications being “prescribed inappropriately in people aged 65 years and over for their sedative effects – that is, a form of chemical restraint for people with psychological behavioural symptoms of dementia or delirium” (1).
The Department has provided residential aged care facilities with the Guiding principles for medication management in residential aged care facilities to assist managers and staff in providing safe, quality use of medicines.
In announcing better regulation of chemical and physical restraint in residential aged care, then Minister for Senior Australians and Aged Care Ken Wyatt referred to the work of Dementia Training Australia (DTA) to upskill the aged care workforce in this area.
We offer a Medication Management Consultancy as part of our Tailored Training Packages for aged care organisations.
The Medication Management Consultancy aims to help reduce antipsychotic medication use for responsive behaviours, promoting safe and quality use of these medications if they are prescribed. Supporting and empowering staff to work towards practice change, through the development of sustainable processes based on evidence-based guidelines, forms a key facet of this consultancy.
Already we have seen great improvements for both residents and staff within many organisations who have completed the consultancy, including our work with Baptistcare at the Dryandra site.
DTA also offers:
- the Antipsychotic Tracking Tool (APTT), which helps aged care providers monitor their use of antipsychotic medications by generating audit reports and graphs to determine prevalence of use
- a one-hour online course
- a Medication Management App (also available as self-print quick reference cards).
It is important that organisations and staff feel confident in addressing the new standards, and these resources can assist in preparing for accreditation. More importantly, they can improve practice regarding antipsychotic medication use in residential aged care, ultimately leading to better outcomes for residents and staff.
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Disclaimer – The views and opinions in this blog are those of the author and do not represent the Commission or Department of Health.
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