10 signs of adverse events and psychotropic medicines

In a bid to empower carers and minimise drug-related harm in older people, a recent study by Monash University has identified the top 10 signs of adverse drug events to look for in aged care residents using psychotropic medication.

Researchers from the Centre for Medicine Use and Safety (CMUS), within the Monash Institute of Pharmaceutical Sciences (MIPS), led the international study, which included psychiatrists, clinical pharmacologists, GPs, pharmacists, nurses, and carers from 13 different countries across the Asia Pacific, Europe, and North America.

CMUS PhD candidate and Monash Health pharmacist Brigid McInerney, the study's lead author, said the research was part the ongoing improvements to pharmaceutical safety and monitoring in Australia.

“Medication safety is a national health priority area – and residents of aged care facilities are at high risk of experiencing medication-related harm. Our findings will empower nurses and aged care workers to identify when residents are experiencing side-effects,” Ms McInerney said.

“Australia’s new Guidelines recommend all health professionals involved in prescribing, dispensing or administering a psychotropic medication for a resident should be familiar with the adverse event monitoring protocol, and this protocol should be available to residents and their carers’ as well."

The top ten signs and symptoms

• Recent falls
• Daytime drowsiness or sleepiness
• Abnormal movements
• Confusion or disorientation
• Balance problems
• Dizziness
• Postural hypotension (i.e. dizziness caused by low blood pressure when standing up)
• Reduced self-care
• Restlessness
• Dry mouth

According to the Australian Government's Aged Care Quality and Safety Commission (ACQSC), psychotropic medications are "any drug capable of affecting the mind, emotions and behaviour."

ACQSC states: "the three main classes of psychotropics prescribed are antidepressants, anxiolytic/hypnotics (mostly benzodiazepines to manage anxiety and insomnia) and antipsychotics. Other psychotropic classes include anticonvulsants and stimulants."

"Because they affect the brain and mind, anti-dementia medication and opioids can be classed as psychotropic medication. When more than one psychotropic agent is used, especially in the elderly, the side effects and risks can be compounded."

New psychotropic medicines guidelines by the Australian Commission on Safety and Quality in Health Care were released in May, in direct response to the Royal Commission, which detailed serious breaches of human and legal rights and brought to light the many safety issues relating to the use of psychotropic medicines in people experiencing cognitive decline.

The new guidelines aim to ensure safe and appropriate use of psychotropic medicines, with the rights, dignity, health, and quality of life of older people as the top priority.

Based on the Monash study, CMUS researchers have developed a monitoring tool to help simplify safe psychotropic use and aid nurses and aged care staff in efficiently identifying adverse events in residents.

“We anticipate that this short, easy-to-use checklist can be for routine use in different residential aged care facilities. This may facilitate proactive monitoring and early detection of adverse drug events and avoid further medication-related harm.”