Letters
Ageing Statistics Pharmacology
Volume 199 - Issue 2

Rethinking psychotropics in nursing homes

Authors:  Sarah N Hilmer and Danijela Gnjidic

Med J Aust 2013; 199 (2): 99. || doi: 10.5694/mja13.10353
Published online: 22 July 2013
In reply: We thank Westbury and Peterson, and Mykyta for highlighting some of the issues raised in our article.1 While we acknowledge the important contribution of providing education programs to existing staff, staff education alone is insufficient to address the complex issues affecting psychotropic drug use in nursing homes.1 Better access to appropriately trained staff in nursing homes, including general practitioners, geriatricians, psychogeriatricians, psychologists, pharmacists, nurses ...
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In reply: We thank Westbury and Peterson, and Mykyta for highlighting some of the issues raised in our article.1

While we acknowledge the important contribution of providing education programs to existing staff, staff education alone is insufficient to address the complex issues affecting psychotropic drug use in nursing homes.1 Better access to appropriately trained staff in nursing homes, including general practitioners, geriatricians, psychogeriatricians, psychologists, pharmacists, nurses or nursing aids, is required to provide safer alternatives to psychotropics. As we discussed, provision of these services may require changes to our health care and funding models.1

Inappropriate use of psychotropics in nursing homes is a hazard that requires comprehensive risk management strategies. The Australian Work Health and Safety Regulations require risks to be managed according to a hierarchy of risk control, in which education is among the lowest controls and providing safer alternatives is among the highest.2 The hierarchy of risk control may be applied to psychotropic use in nursing homes as follows:

  1. Eliminate the hazard altogether: this is not feasible for psychotropics, which have a limited therapeutic role for nursing home residents.

  2. Substitute the hazard with a safer alternative: invest in more skilled staff to administer non-pharmacological therapies, and in research to develop newer, safer therapies.

  3. Isolate the hazard from anyone who could be harmed: make policy changes that limit prescribing of psychotropics by indication, dose and duration, and promote withdrawal3 to reduce the risk–benefit ratio.

  4. Reduce the risk through engineering controls: use electronic prescribing to reduce inappropriate psychotropic use.

  5. Reduce the risk through administrative controls: educate and train existing staff.

  6. Use of personal protective equipment: residents who are administered psychotropics should wear hip protectors.

    7. A multifaceted approach to psychotropic use is required to optimise the safety of the vulnerable people living in nursing homes.

Authors

  • Sarah N Hilmer1
  • Danijela Gnjidic1
  • 1. Royal North Shore Hospital and University of Sydney, Sydney, NSW.

Correspondence: sarah.hilmer@sydney.edu.au

Competing interests

We conduct a program of research on optimising medication use by older people.

Acknowledgements

Danijela Gnjidic is supported by a National Health and Medical Research Council Early Career Fellowship.

References

View this article on Wiley Online Library

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