Psychotropic medicines in people with learning disabilities whose behaviour challenges
Key Therapeutic Topics from NICE pages 11-19.
Plus this Document ‘Stopping overmedication of people with learning disabilities’
In part one of this two part blog I suggested that patients themselves need to take more responsibility for the medicines they are prescribed.
But what about vulnerable groups who may depend on decisions being made for them, and in their best interests?
- Most of the prescribing in this area is ‘off label’ ( #jargonbuster – that’s medicines prescribed for something that isn’t listed as an ‘indication’ for that medicine ).
- This prescribing can include multiple psychotropic medicines, often medicines in the same class and without relevant indications. There is no evidence base for this type of prescribing.
( #jargonbuster – psychotropic medicines = The phrase “psychotropic drugs” is a technical term for psychiatric medicines that alter chemical levels in the brain which impact mood and behaviour.)
- Psychotropic medicines in people with learning disabilities whose behaviour challenges are not always prescribed by a specialist in this area.
Actions to take:
- A Holistic assessment.
Before prescribing it’s important to understand all triggers and environmental factors. Reasons for behaviour now and what has happened in the past.
- Specialist initiation and review of prescribing.
- Multi-Disciplinary team involvement.
- Best interests decisions, regularly reviewed.
- A tiered approach to prescribing – ‘start low, go slow’.
- Involvement of Second Opinion Appointed Doctors (SOADs) to provide a statutory safeguard where consent is an issue.
‘SOADs visit the person and explore the current and proposed treatment, certifying what is considered to be appropriate and reasonable in circumstances where the person cannot or does not consent to it, discussing it with team members and the person before reaching their conclusions.’
- Clear documentation:
- Of the holistic assessment
- Of patient involvement
- Of carer and family involvement
- Of multi-disciplinary team involvement
- Of the rationale for prescribing / not prescribing
- Review dates and evidence of reviews
- Monitoring of the effect of the medicine(s) that includes as required ‘prn’ medicines (Charts can be useful)
- Evidence of changes in response to the medicine(s) not being as expected, including if the medicines has no effect, and the actions taken on this.
This important subject deserves a blog of its own. Feedback and views welcome, send them to firstname.lastname@example.org
More on the NICE Key Therapeutics Document here:
Personal views of Steve Turner RGN; RMN; Ba (Hons); P.G. Dip Ed; MIHM
Steve is a nurse prescriber and NICE Medicines and Prescribing Programme Associate.
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For part one of this blog ‘Medicines are overused’ click on the image below: