Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard
The Commission is developing a clinical care standard to reduce the inappropriate use of psychotropic medicines in people with cognitive disability or impairment, particularly when used for managing changed behaviours or behaviours of concern.
The Royal Commission into Aged Care Quality and Safety (Aged Care Royal Commission) and the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (Disability Royal Commission) found that psychotropic medicines are being misused and overused, particularly in older people with cognitive disability or impairment.
Inappropriate use of psychotropic medicines has been recognised as a safety and quality issue in health care.
The Australian Commission on Safety and Quality in Health Care (the Commission), the Aged Care Quality and Safety Commission and the NDIS Quality and Safeguards Commission released a Joint Statement in March 2022 outlining the commitment by these three agencies to work together to reduce the inappropriate use of psychotropic medicines as a form of restrictive practice to control the behaviour of people who exhibit behaviours of concern.
Development of this clinical care standard aims to support the Joint Statement by providing guidance to enable appropriate management and improve outcomes for these vulnerable groups.
Aims of the standard
The Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard (the Standard) aims to support the Joint Statement in the following areas:
- Managing the risks associated with the use of psychotropic medicines for managing changed behaviours or behaviours of concern
- Supporting improvements in diagnosis and assessment, behaviour support planning, and preventative and de-escalation strategies for such behaviours
- Strengthening providers’ understanding and capacity for appropriate informed consent when psychotropic medicines are used for behavioural reasons
- Addressing the appropriateness of prescribing, dispensing, administration, monitoring, and discontinuation of psychotropic medicines.
The Standard will focus on reducing risk for people with cognitive disability or impairment, recognising their high risk and the potential for inappropriate use of psychotropic medicines in this group. Further information on the scope and goals of the Standard will be published in due course.
Consultation and expert advice
Clinicians, consumers and healthcare services will be consulted during the development of the Standard, which will include a public consultation period. The Commission has established a Topic Working Group (TWG) with expertise based on lived experience and from relevant clinical specialities including general practice, research, emergency medicine, psychology, nursing, allied health and geriatric medicine, from states and territories around Australia.
The main roles of the group are to:
- Provide expert advice on the development of the Standard and related guidance materials
- Provide ongoing guidance on the impact of the Standard on key stakeholders
- Acknowledge and take into account the perspectives of a broad range of stakeholders when providing advice to the Commission
- Advise the Commission on the scope and key components of care to be the focus of the Standard
- Advise the Commission on the key sources of evidence to inform the development of the Standard. This might include clinical practice guidelines, clinical standards, systematic reviews and meta-analyses
- Advise on the formulation of quality statements and supporting indicators
- Present potential strategies to the Commission that support the implementation of the Standard
- Actively support raising awareness of the Standard
- Advise the Commission on a review plan for the Standard, and support any associated revision as required
- Actively support consultation on new resources developed
- Provide advice on communication strategies to support new resources
For those who are consumers, a key role is to advise the Commission on matters relating to their experience - whether as a patient or carer - and provide this perspective during the development of the Standard.
All topic working group members are required to disclose financial, personal and professional interests that could, or could be perceived to, influence a decision made, or advice given to the Commission. Disclosures are managed in line with the Commission’s Policy on Disclosure of Interests.
A high-level summary of the activities and timeframes to deliver this clinical care standard is provided in the table below.
These timelines are subject to change.
|Project planning and background research
|Feb - July 2022 (complete)
|Establish Topic Working Group (TWG)
|May - June 2022 (complete)
|Meetings with TWG to define scope and draft quality statements
|August – December 2022 (ongoing)
|April - May 2023 (complete)
|Approvals and endorsement processes
|August - November 2023
|Launch of the standard
Public consultation on the draft Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard and related resources closed on Monday 8th May 2023.
The Commission will review all comments and use them to finalise the clinical care standard.