Leading the change in medication management

DTA’s Medication Management Consultancy is a pivotal pharmacist-led consultancy service reducing antipsychotic usage in residential aged care facilities across Australia.

Responsive behaviours are experienced by the majority of people living with dementia at some point throughout their journey with the condition.

For decades, antipsychotic medications have been used in residential aged care to alleviate responsive behaviours. This is despite these medications being of limited effectiveness for most responsive behaviours, and concerns regarding an increased risk for injury and death for a person with dementia who is prescribed an antipsychotic (TGA 2015).

There is also an increasing body of evidence that addressing responsive behaviours with non- pharmaceutical approaches is at least as effective as using antipsychotic medications (TG Ltd 2016). Consequently, most clinical guidelines that address responsive behaviours recommend that antipsychotic medications should only be considered when all non-medication approaches have failed, and only for severe symptoms of aggression and agitation. However, many residential aged care sites report difficulties in adhering to these guidelines due to various barriers. These include a lack of knowledge regarding the safe withdrawal of these medications, organisational processes that inadequately support decision making for responsive behaviour management, and lack of commitment to changing staff behaviour.

In response to this body of evidence, Dementia Training Australia (DTA) developed a pharmacist-led, evidence-based service that aims to embed knowledge and processes to optimise the use of antipsychotic medications for responsive behaviours. The Medication Management Consultancy (MMC) is a three-tiered process which benchmarks and then follows over time two key measures relating to antipsychotic use. These are: the number of residents prescribed antipsychotic medications for responsive behaviours; and staff knowledge about the appropriate use of psychotropic medications for responsive behaviours within the residential aged care facility (RACF).