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Monday, May 23, 2022

Govt joins united front on inappropriate use of psychotropic medicines in aged care

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The Federal Government has issued its first ever formal joint statement on the inappropriate use of psychotropic medicines, with the Aged Care Quality and Safety Commission (ACQSC), the NDIS Quality and Safeguards Commission (NDIS Commission) and the Australian Commission on Safety and Quality in Health Care (ACSQHC).

The three commissions have released the joint statement to better address the medicines – such as mood stabilisers and sedatives – and their improper prescribing in the treatment of older persons and those with disabilities.

The Royal Commission into Aged Care Quality and Safety revealed that it has been a ‘problem in aged care in Australia for more than 20 years’.

“The inappropriate use of unsafe and inhumane restrictive practices in residential aged care has continued, despite multiple reviews and reports highlighting the problem. It must stop now,” the final report reads.

However, there is evidence that the misuse of chemical restraints continues, with a South Australian aged care facility sanctioned by the ACQSC last November for using a sedative medication for a condition where a topical cream should have sufficed.

Moreover, aged care advocates have questioned the Government’s priorities on the issue, after a last minute addition to the Aged Care and Other Legislation Amendment (Royal Commission Response No. 2) Bill 2021 proposed that legal “immunity” be granted to aged care providers administering restrictive practices under certain conditions, barring families from challenging the practices in court if they suspected abuse.  

The joint statement, therefore, aims to provide some clarity on the federal bodies’ position on the matter, claiming that the three bodies will be prioritising:

  • raising awareness of the risks associated with inappropriate use of psychotropic medicines amongst healthcare, aged care and disability workforces;
  • supporting improvements to the availability and quality of behaviour support planning, and preventative and de-escalation strategies;
  • strengthening understanding and capacity for appropriate informed consent, prescribing, dispensing, administration and cessation of psychotropic medicines.
Greg Hunt MP, minister for health and aged care, says that the joint statement signals the initiation of much needed systemic changes in the aged care sector.

At this stage, the fine details as to how these strategies will be rolled out, on the ground, remain unclear.

Health and aged care minister, Greg Hunt, said that while psychotropics have a place in health care, they should only be used according to accepted medical practice.

“The collaboration to reduce inappropriate use of psychotropic medicines across the three sectors where people with disability and older people receive care, is ground-breaking,” he said.

“It can provide a real opportunity and impetus for the type of systemic change highlighted by both the Disability Royal Commission and the Aged Care Royal Commission.

Senator Linda Reynolds, minister for the NDIS, concurred, saying that minimising the use of restrictive practices, except where absolutely necessary, is paramount for ethical care of Australians with disabilities.

“Today’s landmark joint statement will ensure NDIS participant’s rights to choice and control are protected, improve their quality of life and lead to more positive health and wellbeing outcomes for all Australians with disability.

Senator Linda Reynolds, minister for the NDIS, says that supporting better choice and control over care was central in developing the joint plans to mitigate the over-usage of psychotropic medications in aged and disability services.

Richard Colbeck, minister for aged care and senior Australians, pointed out that the ACQSC has developed a range of resources to inform the aged care sector since new requirements were introduced regarding the use of restrictive practices in July and September 2021.

“The resources developed by the ACQSC are important to help providers to understand their obligation to ensure that restraints, including psychotropic medications, are only used as a last resort,” Colbeck said.

These mentioned ACQSC resources can be found via this link.

More about the use of psychotropic medications in aged care

Psychotropic medications are a class of drug that refers to those capable of affecting the mind, emotions, and behaviour. 

The three main classes of psychotropics prescribed in aged care settings are antidepressants, anxiolytic/ hypnotics and antipsychotics.

These types of medications are indicated for the treatment of symptoms relating to dementia, intellectual disability, autism as well as mental illnesses such as depression, anxiety, bipolar or schizophrenia.

A ‘restrictive practice’ is any action that restricts the rights or freedom of movement of a care recipient; use of a psychotropic medication is classed as a ‘chemical restraint’.

After the royal commission highlighted overuse of chemical restraint in residential aged care settings, amendments were made to the Aged Care Act 1997, tightening the criteria under which any restrictive practice can be administered.

From July 1, 2021, approved residential aged care providers must comply with new legislative obligations, ensuring:

  • restrictive practices of any form should be used as a last resort to prevent harm to a care recipient or others, and after considering how it may impact the care recipient;
  • alternative strategies must be trialled and documented before considering a restrictive practice;
  • the least restrictive form should be used for the shortest time needed;
  • the care recipient or the restrictive practices substitute decision-maker (if the care recipient lacks the capacity) must have given informed consent for the use of the practice;
  • restrictive practices are only to be used in line with the rights and responsibilities of care recipients outlined in the Charter of Rights;
  • monitoring and regular reviews should occur.
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