Page 74 - rp-may-2020

CPD ACTIVITY 72
RET AIL PHARMA C Y • MA Y 2020
FROM PAGE 71
Australian data indicates that just
over half of permanent residents in
residential aged care facilities have
dementia, and that residents aged
over 65 years with dementia have a
higher number of health conditions on
average than all patients in that age
group.
9, 10
Troublesome behaviours are
common in patients diagnosed with
dementia. It’s estimated that more than
90 per cent of patients display at least
one behavioural or psychotic symptom
of dementia, and these symptoms
can vary over time. Some examples
11
of dementia symptoms that could be
considered troublesome include calling
out, wandering, disrobing, or bizarre
behaviour. Given the higher number
12
of health conditions in this population,
it may be difficult to identify if a medicine
is being given to treat a health condition
or being used as chemical restraint.
When considering chemical restraint,
it’s important that the patient be
assessed to ensure there is no
underlying cause for the behaviour.
For example, patients with dementia
who are in pain may display agitated
behaviour and may benefit from pain
management strategies. If a cause is
13
identified, short term treatment for the
behaviour might still be required until
the underlying cause can be adequately
managed. Another potential cause
13
for behavioural problems in older
people can be prescribed medicines,
including anticholinergics, narcotics
or even benzodiazepines. Therefore,
a review of a patient’s medicines may
be warranted.
13
Guidelines recommend that the first-
line approach to behavioural symptoms
of dementia be multidisciplinary,
psychosocial and individualised.
These interventions should be
trialled before a medicine is used,
wherever possible.
6, 14
Evidence of
benefit for a variety of psychosocial
interventions is mixed and depends on
the behaviour being treated. Agitation
may be reduced through the use of
aromatherapy, calming music, massage,
or thermal baths. But these strategies
are unlikely to be of benefit to treat
wandering. Selection of psychosocial
15
intervention(s) should be determined
by the individual patient and the
behaviours displayed.
What rules govern the use of
chemical restraint?
The rules regarding restraint may
differ by state or territory. Healthcare
professionals should be aware of the
rules and regulations applicable to
their location. The use of chemical
restraint is detailed in the Quality of
Care Principles 2014, which stipulate
that both physical and chemical
restraint are to be used only as a last
resort, should be documented, and
consent should be obtained from the
patient’s representative before the
restraint is administered, if practicable.
5
If consent cannot be gained before the
restraint is administered, the patient’s
representative should be informed as
soon as practicable after administration
of the restraint. The use of chemical
5
restraint should be documented, and
this documentation should include
the behaviour(s) prompting the use
of the restraint, what alternatives to
restraint were tried, why the restraint
is required, and any information given
to the practitioner that informed the
prescribing decision. Additionally,
5
while the patient is being restrained,
they should be monitored regularly
for signs of harm or distress, keeping
the prescriber informed about use of
the restraint.
5
The Quality of Care Principles also
state that a medical or nurse practitioner
must assess the individual as requiring
the chemical restraint, and prescribe the
chemical restraint. Due to pressures
5