Meditrax Summary of Understanding Regarding Chemical Restraint Issue 7, Version 1

Meditrax Summary Of Understanding Regarding Chemical Restraint Issue 7, Version 1

There has been some confusion in relation to the definition of “Restraint” in Aged Care and what constitutes a “Chemical Restraint”.

The picture is complex. While each state or territory’s legislation determines what is chemical restraint, the definitions are variable and inconsistent. Consent legislation also varies. In NSW, it is necessary to have consent from the person responsible for the use of all medications which affect the central nervous system and are considered ‘major’ treatment. This includes all psychotropic medications (apart from where considered ‘minor’ treatment such as anti-nauseants used once only).

Guidance material in relation to restrictive practices in aged care facilities includes the Department of Health and Ageing’s 2012 publication: Decision-Making Tool: Supporting a Restraint Free Environment in Residential Aged Care. This resource has the following information:

‘Chemical restraint’ is the control of a resident’s behaviour through the intentional use of:

• prescribed medicines • over the counter medicines and/or • complementary alternative medicines.

Chemical restraint is:

• when no medically identified condition is being treated • where the treatment is not necessary for a condition • to over-treat a condition.

Chemical restraint includes the use of medicines when:

• the behaviour to be affected by the active ingredient does not appear to have a medical cause • part of the intended pharmacological effect of the medicine is to sedate the person for convenience or for disciplinary purposes.

Examples of pharmacological agents used as chemical restraint are antipsychotic, antidepressant, antimanic, anxiolytic and hypnotic drugs. Chemical restraint – medicines which sedate or tranquillise – must not be implemented until alternatives are explored extensively through assessment.

Any medication that has psychotropic action is in effect a chemical restraint, as these medications may all influence a person’s behaviour, mental state and physical function, whether prescribed regularly or on a PRN basis. In the majority of cases, the use is appropriate, as the treatment benefits of improved well-being and quality of life outweigh the risks of adverse effects.

For Residential Aged Care Facilities throughout Australia, there is a need to have documentation of the ongoing indications for treatment with psychotropic medications, and to ensure their dosage and frequency of administration are regularly reviewed so that use is minimised and there is not a situation of inappropriate chemical restraint.

Where there is not regular review, and particularly if other psychotropic medications are added, the combined adverse

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Studies have confirmed that non-pharmacological strategies are first-line in behaviour management and should always be tried based on an individualised behaviour management plan, before medication is considered. The strategies tried should be documented in association with any clinical decision to administer a PRN psychotropic agent for a situation of behaviour management.

The Meditrax Psychotropic Audit checks all resident history, notes, discharge and other paperwork and specialist letters, to determine if there is documentation of the diagnosis or indication to support the use of medications that are prescribed for their psychotropic action. The report provides an opportunity to request prescribers to review medications where the documentation is not located or is unclear, and where PRN medications have not been used.

The Meditrax Psychotropic Management Form can be utilised by facilities to ensure there is documentation by prescribers of the intended use of a psychotropic medication, i.e. the diagnosis or indication for use, as well as documentation of regular review. It also allows the prescriber to indicate that consent was obtained. It should be updated with each medication or dosage change.

The Meditrax Psychotropic Consent Form can be utilised to record written consent for the use of psychotropics, especially where used for behaviours associated with dementia, or where the facility wants to have clear evidence that the person responsible has consented to the use of a psychotropic medication. The facility can choose the frequency of consent (e.g. with dosage changes and/or at each regular review of the medication use), however it should be obtained at a minimum of the following: before commencement of treatment, with any dosage change, and before cessation of treatment. It is also important to ensure the right ‘person responsible’ gives the consent, and that the consent was informed with the aims of the treatment, intended length of the treatment and the common potential adverse effects. Facilities should be able to demonstrate in documentation that such consent was obtained.

With the use of the Psychotropic Management and Consent Forms which should clearly document the diagnosis/indication and the consent that is required, it is Meditrax’ understanding that there is not a further requirement to have separate ‘Chemical Restraint’ authorisation forms as well.

In summary, it is important that the focus of Residential Aged Care Facilities in psychotropic medication management is to ensure there is documentation and regular review of appropriate diagnoses or indications, and consent, for the use of psychotropic medications.

The above information is based on the interpretation of current requirements by Senior Meditrax Pharmacists from legislation, guidelines for the Aged Care Quality Standards, and discussions with senior and clinical advisory personnel within the Aged Care Quality and Safety Commission

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