Page 73 - rp-may-2020

2
CPD CREDITS
CPD ACTIVITY
71
RET AIL PHARMA C Y • MA Y 2020
Nicole Dilworth, BPharm (Hons), AACPA
Nicole Dilworth has a Bachelor of Pharmacy with Honours from the University of Tasmania, where she is currently studying Professional Honours
in Clinical Pharmacy. She is AACP accredited to perform medication reviews. She has a Diploma of Leadership and Management and is a
clinical educator.
CHEMICAL RESTRAINT IN AGED CARE
LEARNING OBJECTIVES
After completing this CPD activity,
pharmacists should be able to:
• Describe the types of restraint that
may be used in the aged care setting
and why chemical restraint may
be prescribed.
• Discuss how unwanted behaviours in
aged care should be managed and
the legislation applicable to the use of
chemical restraint.
• Identify medicines utilised for chemical
restraint and the risks associated with
their use.
• Describe how pharmacists can
contribute to the appropriate prescribing
of psychotropics for chemical restraint.
2016 Competency Standards:
1.1, 1.2, 1.3, 1.5, 2.1, 2.2, 2.4, 3.1, 3.2, 3.3, 3.5.
Accreditation number:
A2005RP1 (exp: 30/04/2022).
Introduction
The use or misuse of chemical restraint
in Australia and overseas has been
the subject of recent focus. In the US
and Australia, research examining the
prevalence of psychotropic prescribing
has shown that more than two thirds
of people in residential aged care
are prescribed one or more regular
psychotropic medicines. In 2018 the
1,2
Australian Government established
the Royal Commission into Aged
Care Quality and Safety to investigate
the quality of care provided by the
aged care system in this country.
3
The Royal Commission published an
interim report in 2019, identifying areas
requiring urgent action, including an
overreliance on chemical restraint in
residential aged care.
4
Chemical restraint is not only used in
the aged care setting. It may be used
elsewhere, such as in mental health,
disability, or emergency departments.
What is chemical restraint?
Two types of restraint are used in
healthcare settings: physical and chemical.
Physical restraint (also known as
mechanical restraint) is use of methods
that physically restrict a person’s
movement or behaviour. Physical
5
restraints include obvious strategies
such as bedrails confining a patient to
their bed, or more subtle methods such
as removing an elderly patient’s walker
so they’re unable to mobilise. Use of
physical restraint may be confronting
and distressing to the patient, their
family and to others present or nearby.
6
Such use may be associated with injury
to the patient, deterioration (eg, loss of
muscle mass) and possibly even death.
4,7
The alternative method of restraining
a patient is chemical. The term
‘chemical restraint’ refers to the use of
medicines for the purpose of controlling
or influencing a person’s behaviour.
5
The Australian government’s ‘Quality
of Care Principles 2014’ state that if a
medicine or chemical substance is being
used to treat, or enable treatment of,
a diagnosed medical condition, it’s not
considered to be chemical restraint.
5
The intent of the prescriber is therefore
critical in identifying if a medicine is
being given to treat a medical condition,
for example hallucinations in mental
illness, or to influence behaviour, such
as aggression in dementia. Chemical
restraint is thus difficult to define
because the prescriber’s intent is not
always clear.
4
Although chemical restraint may be
less visually confronting than physical
restraint, patients and their family
may still find the use of chemical
restraint distressing.
8
Why use chemical restraint in the
aged care setting?
Chemical restraint may be used in the
aged care setting to modify unwanted or
potentially harmful behaviour. Some of
the behaviours that may lead to the use
of chemical restraint, sometimes known
as ‘challenging behaviours’, may include
restlessness, agitation, aggression,
or not following institution and/or
social rules.
4
TO PAGE 72