The Aged Care QI Program: Medication Management (Polypharmacy and Antipsychotics)
Published: 23 November 2021
Published: 23 November 2021
A report from the Pharmaceutical Society of Australia in 2020 found that 95% of Australian aged care residents were experiencing at least one problem with their medicines. Furthermore, over half of all aged care residents were found to have been prescribed potentially inappropriate medicines (PSA 2020).
Older adults often need to take a variety of medicines due to age-related chronic illness, with about 80% of people over the age of 65 having at least one chronic condition (ACSQHC 2021). However, the physiological processes of ageing make older people more sensitive to the effects of medicines and cause their bodies to respond differently, increasing their risk of experiencing adverse events and interactions (PSA 2020).
Inappropriate medicine use has the potential to cause a variety of negative health outcomes including falls, admission to hospital, adverse drug reactions and even mortality, yet, inappropriate prescribing continues to be a widespread and complicated issue in residential aged care (ACQSC 2020).
In order to address this issue and improve the quality of care for older adults, The National Aged Care Mandatory Quality Indicator Program (QI Program) introduced a new quality indicator on 1 July 2021 requiring all government-subsidised residential aged care providers to collect and report data on two significant aspects of medication management: polypharmacy and antipsychotics (Pozydajew 2021; DoH 2021).
Polypharmacy is common among older adults, with two-thirds of people aged over 75 taking five or more medicines simultaneously (ACSQHC 2021).
While polypharmacy is necessary in some cases, it carries significant risks and has been associated with serious consequences, including:
(ACSQHC 2021; DoH 2021)
Under the QI Program, polypharmacy is defined as the prescription of nine or more medicines to a single care recipient (DoH 2021).
The medicines included in this count are all medicines (both prescription and non-prescription) with an active ingredient, except for:
Under the QI Program, residential aged care providers must collect and report data on the number of residents who have been prescribed nine or more medicines (DoH 2021).
This data collection must take place on a single collection date every quarter (DoH 2021).
Providers must review the medication charts and/or administration records of all care recipients and report the following information:
Antipsychotics are a type of medicine intended to treat diagnosed psychosis (e.g. schizophrenia bipolar disorder, Huntington’s chorea, delusions and hallucinations, psychosis while receiving end-of-life care) (DoH 2021).
Despite this, many aged care residents are prescribed antipsychotics in order to manage behavioural and psychological symptoms of dementia (BPSD), despite this practice being contraindicated due to evidence of harm (ACQSC 2020; DoH 2020).
About one in five aged care residents are taking antipsychotics. Many of these people are also taking high doses for a longer period of time than recommended (PSA 2021; ACQSC 2020).
As well as being potentially harmful, antipsychotics are also unlikely to result in significant benefits when used to manage BPSD (Welberry et al. 2021).
The Department of Health (2020) states that antipsychotics should be prescribed as the exception, not the norm. Even in cases where antipsychotics are indicated, most people benefit from short-term use only (PSA 2021).
The use of antipsychotics in older adults may be associated with adverse effects such as:
(ACSQHC 2021; PSA 2021; ACQSC 2020)
Under the QI Program, residential aged care providers must collect and report data on the number of residents who have received antipsychotics (DoH 2021).
The provider must identify a data collection date every quarter. The collection date, and the six days prior to that date, form the seven-day assessment period during which the medication charts and administration records for all care recipients must be assessed for antipsychotics (DoH 2021).
Providers must collect and report the following information:
Question 1 of 3
True or false: It’s appropriate to prescribe antipsychotics to manage behavioural and psychological symptoms of dementia (BPSD).
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