New information resources to support prescribers in aged care

Since 2019, the Department of Health has undertaken a series of activities to minimise the use of restrictive practices, including the use of antipsychotics in residential aged care. While prescribing antipsychotic and benzodiazepine medications can be clinically appropriate in some circumstances, in the past they were often relied on by aged care providers to address dementia behaviours, such as inappropriate verbalisation, intrusive behaviours or so-called ‘wandering’.

Evidence suggests that these medications do not address many behaviours of dementia but can often cause harm including increased risk of falls and fractures, confusion, loss of independent function, weight loss and loss of ability to interact meaningfully with others.  It may also result in a slowing of movements and increased muscle rigidity, leading to increased risk of respiratory complications, stroke, heart rhythm abnormalities and death.

As part of the announced changes, responsibilities of providers for minimising, monitoring and reviewing the use of restraint have been clarified, including:

• the outcome of the use of restrictive practice and whether the intended outcome was achieved

• whether an alternative strategy or less restrictive practice could be used

• whether there is ongoing need for its use.

Obligations have also been strengthened to ensure that restraint is only used as a last resort to prevent harm after alternative best practice behaviour management strategies and interventions have been considered, applied and documented.

Given these changes, it is likely that aged care providers may ask prescribers for additional information around restrictive practices prescribed to ensure they meet their responsibilities as approved providers.

The newly released resources to support the prescribers include:

• A webpage dedicated to minimising the use of restrictive practices that includes information and guidance for medical practitioners: www.health.gov.au/health-topics/agedcare/providing-aged-care-services/working-in-aged-care/restrictive-practices-in-aged-care-alast-resort.

• The Restrictive Practice Use in Aged Care Facilities fact sheet www.health.gov.au/resources/publications/restrictive-practice-use-in-aged-care-facilitiesoverview

• A 6 steps for safe prescribing factsheet that provides guidance around the safe prescribing of psychotropic medications: www.health.gov.au/resources/publications/six-steps-for-safe-prescribing-of-antipsychoticsand-benzodiazepines-in-residential-aged-care.

The Department of Health is encouraging all prescribers of psychotropic medications to consider the clinical appropriateness of prescribing these medications to patients in aged care settings and consider the appropriateness of alternative approaches to treatment before looking to psychotropic medications.