New training to improve safety of psychotropic medications

Researchers have developed new training modules for aged care workers and nurses to reduce medication misuse in restrictive practices in residential aged care.

Restrictive practices include the use of medication to sedate people in residential aged care to control movement or decision-making.

In 2021, the Royal Commission warned the 'clear overuse of physical and chemical restraint in residential aged care was a major quality and safety issue.'

Scientists from Monash's Centre for Medicine Use and Safety (CMUS) teamed up with aged care provider Good Shepherd Lodge to create training for staff on safe medication use in aged care.

Nurses and aged care workers can enrol in nine modules focusing on the appropriate use of antipsychotic, benzodiazepine, and antidepressant medications for those with dementia. 

"Education plays a vital role, so we've created three education series for nurses and aged care staff," program leader and Monash Health pharmacist, Brooke Blakeley, said.

Aged Care Insite spoke with Blakeley about how aged care staff and nurses can protect people in aged care from medication-related harm.

ACI: How do the modules contribute to reducing chemical restraint in residential aged care?

BB: The Royal Commission into Aged Care Quality and Safety recognised the consistent overuse of psychotropic medications as a cause of the commission's findings. 

This led to identifying the need for this new clinical practice guideline on psychotropic medications in people living with dementia and in residential aged care. 

Antipsychotics, benzodiazepines and antidepressants are the three most common psychotropic medications implicated in restrictive practice in residential aged care. 

Therefore, the clinical practice guideline focuses on these medications and supports their appropriate use in people living with dementia and in residential aged care.

Education plays a vital role, so we've created three education series for nurses and aged care staff. 

Each series is based on a different psychotropic medication, specifically antipsychotics, benzodiazepines, and antidepressants. 

Three one-hour education activities cover adverse events, monitoring, and discontinuation. 

Each activity examines the risks and benefits of the medication for people with dementia and outlines the steps care staff can take when considering initiation, adverse events, and monitoring. 

We review the key adverse events of the medication and what staff should monitor once it's initiated. 

The last activity considers when discontinuation should be considered and what to monitor during the process.

These discussion-based activities allow nurses and care staff to share experiences and promote group discussion. 

We aim to provide practical advice and support on the Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications for People Living with Dementia and in Residential Aged Care.

We published this guideline on April 6th this year, and it includes 15 conditional recommendations and 49 good practices for the three medications covered in the education activities.

It's accessible through the MAGICapp, a web-based tool that can be used on any device. 

What role do aged care workers and nurses play in watching out for adverse responses to medication, specifically for people living with dementia?

Nurses and aged care staff are crucial in ensuring the appropriate use of psychotropic medications for people with dementia. 

These healthcare professionals have the advantage of knowing the individuals they care for on a daily basis, allowing them to identify unmet needs such as social isolation or discomfort and implement non-pharmacological strategies. 

In cases where psychotropic medication is deemed necessary, nurses and care staff are well-equipped to monitor the medication's effects on the person living with dementia, including any adverse events or side effects. 

Additionally, these healthcare professionals have a key role in the discontinuation process. 

The education activities aim to further support nurses and care staff in promoting the appropriate use of psychotropic medications for people with dementia.

What challenges are there for aged care workers in monitoring medication use in people living with dementia?

There are some really important things that we want to monitor for. 

Medications are associated with risks, and we really want to make sure we monitor those.

If a person living with dementia is initiated on psychotropic medication, we want to have a clear protocol for adverse events or side effect monitoring. 

We also want to monitor the effect of the psychotropic medication. 

Psychotropic medication should only be initiated for specific target symptoms, and the anticipated treatment outcome should be identified, quantified, and documented. 

We want to monitor the psychotropic medication's effect on the target symptom, whether it's improving, staying the same, or getting worse. 

We also want to monitor for adverse events, as we mentioned earlier. 

These are just some important key points that the guideline speaks to and that we highlight in the education activities.

How much training is currently accessible for people working in aged care?

The level of training can vary across different residential aged care facilities.

The guidelines suggest various interventions, including education and medication regimens should be reviewed regularly.  

The review should be multidisciplinary and include the person living with dementia’s regular prescriber and their substitute decision-maker.

We hope our education activities can support health and care professionals in implementing these recommendations and practices for psychotropic medications.

In what ways do you hope it'll improve outcomes for people living with dementia in aged care?

The guidelines emphasise that the care for people living with dementia should prioritise their specific physical, emotional, and spiritual needs. 

Psychotropic medications should not be the first line of treatment for managing changed behaviours in people with dementia. 

Instead, the guideline recommends assessing unmet needs and providing non-pharmacological interventions for an adequate amount of time before considering psychotropic medications. 

Even if medication is prescribed, non-pharmacological strategies should still be continued alongside the medication. 

The first education activity in our program focuses on assessing and addressing unmet needs and providing non-pharmacological interventions.

Since the guideline only covers the medication process, it does not mean that it should be read alone. 

Other guidelines and resources that guide or assist in implementing non-pharmacological strategies should be consulted. 

This is one of the key outcomes of the education activities. 

Regarding psychotropic medication use, the focus should be on monitoring the medication's effect. 

The guideline recommends having a psychotropic adverse event monitoring protocol, which can assist the team, including the person with dementia, in monitoring the medication's effect. 

Lastly, the guideline provides detailed advice on when and how to consider discontinuing or stopping psychotropic medication, as well as what to look for.

Could you share some of the practical sides of the modules?

There are nine educational activities, each one hour long. 

We have kept them concise as we understand that people in residential aged care are time-poor and very busy. 

The education activities are standalone, meaning attendees do not have to attend previous activities to be able to attend later ones. 

Ideally, we would like them to be face-to-face as they are interactive and case-study-based. 

Nurses and aged care staff work in small groups to run through a case study and then discuss their answers as a group at the end. 

Being face-to-face allows attendees to share their experiences and have meaningful discussions during the one-hour session.

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