16 Dec 2019 2 min read

Leading the change in medication management

Nurse serving dementia patients

Kate Fulford and Andrew Stafford report on the findings from the first two years of the Dementia Training Australia Medication Management Consultancy

DTA currently uses different terms for behaviour. We will be progressively moving to the term Changed Behaviour in all our content.

DTA’s Medication Management Consultancy is a pivotal pharmacist-led consultancy service reducing antipsychotic usage in residential aged care facilities across Australia.

Responsive behaviours are experienced by the majority of people living with dementia at some point throughout their journey with the condition.

For decades, antipsychotic medications have been used in residential aged care to alleviate responsive behaviours. This is despite these medications being of limited effectiveness for most responsive behaviours, and concerns regarding an increased risk for injury and death for a person with dementia who is prescribed an antipsychotic (TGA 2015).

There is also an increasing body of evidence that addressing responsive behaviours with non- pharmaceutical approaches is at least as effective as using antipsychotic medications (TG Ltd 2016). Consequently, most clinical guidelines that address responsive behaviours recommend that antipsychotic medications should only be considered when all non-medication approaches have failed, and only for severe symptoms of aggression and agitation. However, many residential aged care sites report difficulties in adhering to these guidelines due to various barriers. These include a lack of knowledge regarding the safe withdrawal of these medications, organisational processes that inadequately support decision making for responsive behaviour management, and lack of commitment to changing staff behaviour.

In response to this body of evidence, Dementia Training Australia (DTA) developed a pharmacist-led, evidence-based service that aims to embed knowledge and processes to optimise the use of antipsychotic medications for responsive behaviours. The Medication Management Consultancy (MMC) is a three-tiered process which benchmarks and then follows over time two key measures relating to antipsychotic use. These are: the number of residents prescribed antipsychotic medications for responsive behaviours; and staff knowledge about the appropriate use of psychotropic medications for responsive behaviours within the residential aged care facility (RACF).

The MMC has been undertaken by three large residential aged care organisations across Australia over the past two years, where considerable benefits in both measures have been identified. Across 10 locations, five RACFs have seen greater than a 50% reduction in the proportion of residents using antipsychotics, with up to 60% reduction facility-wide at one location, and 67% reduction across the dementia support unit (DSU) within another.

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