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Quality use of antipsychotics for behavioural and psychological symptoms of dementia

 

Aged care quality use of medicine reports

A collaboration between NPS MedicineWise and Webstercare NPS Medicinewise and Webstercare QUM reports

To support the appropriate prescribing of antipsychotic medicines in residential aged care, NPS MedicineWise has collaborated with Webstercare to design a new Quality Use of Medicine (QUM) report within the Webstercare Medication Management Software (MMS). This enables pharmacies to create in-depth reports about the use of antipsychotic medicines in residential aged care facilities (RACFs).

 

Why focus on antipsychotic medicines?

While there is a role for the use of psychotropic medicines (antipsychotics, hypnotics, anxiolytics and antidepressants) in RACFs evidence suggests that there are instances where these medicines are being used too often, for too long, at doses higher than recommended or in potentially dangerous combinations with other medicines.1,2

Antipsychotics should be used cautiously and only when the benefits outweigh the risk of harm, use requires careful monitoring. Non-drug approaches, such as changes to the environment and behavioural therapies should be considered as the initial treatment option.Behavioural and psychological symptoms of dementia are often transient — therefore antipsychotics should be reviewed regularly (such as 3 monthly). When possible, attempts should be made to gradually withdraw these medicines.3–5 

 

How will the QUM reports help RACFs?

These reports will assist RACFs to:

  • understand and analyse their antipsychotic medicine usage, and monitor changes over time
  • meet accreditation standards related to continuous improvement, medication management and behavioural management (standards 2.1, 2.7 and 2.13)*
  • improve resident care in line with evidence-based guidelines.

The reports provide:

  • objective measurement to help guide appropriate use of antipsychotics
  • comparison of antipsychotic medicine use against published results and guidance to interpret results
  • lists of residents using antipsychotics to identify and prioritise those who may benefit from a medicine review
  • where to go for more information about managing behavioural and psychological symptoms of dementia.

 *report provision alone will not meet these standards. It is the responsibility of an RACF to review and action the information provided by these reports.

 

How do I access these reports?

These reports are available in the May 2013 update of Webstercare’s Professional and Professional Plus Medication Management Software (MMS).

They can be easily obtained from the pharmacy service provider to an RACF (if they use the Webstercare Medication Management Software).

 

Supporting resources

NPS MedicineWise has developed resources to use in conjunction with the QUM report:

Antipsychotic action plan

This plan can be used in collaboration with the resident lists to identify and prioritise residents who would benefit from a review of treatment. Suggested action points are provided for facility nursing staff, to assist a prescriber to review treatment.

The resident lists and action plan may also be useful to accredited pharmacists to help identify residents who may benefit from a Residential Medication Management Review (RMMR). 

Download the antipsychotic action plan

Antipsychotic review checklist 

A simple tool to facilitate the multi-disciplinary review process. It also provides a convenient way to document the review process and outcomes. 

Download the antipsychotic review checklist.  

 

Where do I go for more information and support?

If you have questions about the clinical content of the QUM report or are looking for more information about these resources, please contact NPS MedicineWise on 02 8217 8700 (and select option 2) or by email.

Assistance for pharmacy 

If you are a pharmacy requiring assistance in setting up these reports, call Webstercare’s Software Support Team on 1300 132 466.

Pharmacy service providers

Contact Webstercare on 02 9563 4900 or via email if you are a pharmacy service provider requiring guidance on how to enter data for the maximum benefit when using the QUM report.

For more information about Webstercare please visit www.webstercare.com.au

 

References

  1. Hilmer S, Gnjidic D. Rethinking psychotropics in nursing homes. Med J Aust 2013;198:77.
  2. Westbury JL, Jackson S, Peterson GM. Psycholeptic use in aged care homes in Tasmania, Australia. J Clin Pharm Ther 2010;35:189-93.
  3. AMH drug choice companion: aged care. Third ed. Adelaide: Australian Medicines Handbook Ltd,, 2010.
  4. Therapeutic guidelines: psychotropic. 6th ed. Melbourne: Therapeutic Guidelines Ltd, 2008.
  5. Practice Guideline 10: Antipsychotic medications as a treatment of behavioural and psychological symptoms of dementia: The Royal Australian and New Zealand College of Psychistrists, 2009.
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