Change is here – amended legislation on chemical restraints in Australia
- aged care quality standards
- antipsychotic medication
- education and training
- leadership
- medication management
- opinion
- reducing medications
- residential aged care
- standard 3
DTA’s Medication Management Consultancy has seen as much as a 60% relative reduction in antipsychotic medications prescribed within residential aged care facilities across Australia.
From July 1st 2019, changes to how Residential Aged Care organisations must, by law, monitor and review medications which may be deemed to be a chemical restraint came into effect.
These changes are to ensure that these medications are reviewed regularly and used for the shortest possible period.
There is growing concern regarding potential over – and inappropriate – use of psychotropic medications, such as antipsychotics and other sedatives, in older people, especially those living with dementia. In response to mounting evidence of the significant risks these medications carry, and that it is often a violation of human rights, the Australian Government has amended the Quality of Care Principles 2014 to restrict the use of chemical restraints in Australian Residential Aged Care Facilities (RACFs).
The Principles define chemical restraint as, “the use of medication or a chemical substance for the purpose of influencing a person’s behaviour other than medication prescribed for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition” (1). Examples of a chemical restraint include an antipsychotic medication prescribed to stop a resident wandering at night-time.
The new legislation requires RACFs to provide significant additional documentation regarding residents when restraint is being considered or used. This includes:
- efforts taken to support individuals with non-pharmacological strategies prior to commencing a chemical restraint;
- proof of continuous monitoring and withdrawal attempts taken by the facility to minimise the use of restraint.
The Aged Care Quality and Safety Commission has announced they will seek evidence of meeting the amended legislation by requiring extensive documentation of all residents prescribed psychotropic medications to be produced during unannounced site visits, particularly documentation of all residents prescribed antipsychotic medications and benzodiazepines.
Working together to reduce the use of antipsychotic medications
Our Medication Management Consultancy (MMC) imparts residential aged care staff with the skills to develop an evidence-based plan to minimise the use of antipsychotic medications. Offered only within a broader Tailored Training Package, the MMC is a pharmacist-led service that works closely with key RACF staff members to develop an antipsychotic review process. We work with clients to focus on strengthening non-pharmacological interventions, developing and documenting a comprehensive review process when an antipsychotic medication is prescribed, and monitoring for signs of ineffectiveness and adverse effects.
The DTA MMC has successfully partnered with RACFs across Australia over the past two years and has seen significant improvement across the board; through our consultancy we have seen up to a 60% reduction in the proportion of residents using antipsychotic medications facility- wide, and almost a 70% reduction by one dementia specific unit.
The MMC’s success may be attributed to increased staff knowledge and confidence in recognising the limited place antipsychotics play in supporting a person living with dementia, and utilising the knowledge and skills learned from other activities undertaken in the Tailored Training Package.
Support your organisation in taking steps towards meeting this new legislation by enquiring in our Medication Management Consultancy now.
About this article
This opinion piece was written by:
Medication Management Consultant
Bronwen is based at University of Western Australia (UWA) in Perth
Disclaimer – The views and opinions in this blog are those of the author and do not represent the Commission or Department of Health.
References
- Minimising the Use of Restraints 2019 (Cth)
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