Page 77 - rp-may-2020

CPD ACTIVITY
75
RET AIL PHARMA C Y • MA Y 2020
Chemical restraint in aged care
This activity has been accredited for 1 hour of
Group One CPD (or 1 CPD credit) suitable for
inclusion in an individual pharmacist’s CPD
plan which can be converted to 1 hour of Group Two CPD (or 2 CPD
credits) upon successful completion of relevant assessment activities.
1. Which of the following statements is CORRECT?
A) The term ‘chemical restraint’ refers to the use of medicines
to control a patient’s behaviour or to enable treatment of a
medical condition.
B) The use of chemical restraint is difficult to define since a
prescriber’s intent is not always clear.
C) Chemical restraint is only used in the aged care setting.
D) Chemical restraint should never be used since it is unethical.
2. Which of the following is NOT a behaviour that may lead
to the use of chemical restraint?
A) Rule breaking.
B) Restlessness.
C) Apathy.
D) Aggression.
3. Before prescribing and administering chemical restraint,
which of the following actions should be taken?
A) Attempts should be made to obtain consent from the patient or
their representative.
B) The patient should be reviewed for potential causes or factors
contributing to the behaviour.
C) Individualised psychosocial interventions should be trialled.
D) All the above.
4. The Quality of Care Principles 2014 requires certain information
to be documented in the care and services plan for the
consumer. This documentation should include:
A) Details of the behaviour leading to use of the restraint, what
alternatives have already been trialled, why the patient requires
restraint, and what information was provided to inform the
prescribing decision.
B) Details of the behaviour leading to the use of the restraint, why
the patient requires restraint, and what information was provided
to inform the prescribing decision.
C) Details of the behaviour leading to the use of the restraint,
what alternatives have already been trialled, how the restraint
will benefit the facility, and why the patient requires restraint.
D) Details of the behaviour leading to the use of the restraint,
the intended duration of the restraint, why the patient requires
restraint, and what alternatives have already been trialled.
5. Which of the following statements is CORRECT?
A) Evidence suggests that behaviours such as agitation, wandering,
calling out, and aggression can be successfully controlled using
antipsychotics.
B) Antipsychotics are appropriate in all types of dementia, including
Lewy body dementia.
C) Antipsychotics are known to increase the mortality risk in older
adults, with this risk increasing with the number of psychotropic
medicines taken concomitantly.
D) Risperidone should be initiated at a dose of 2mg a day, increasing
the dose by 0.25mg every two or more days if necessary.
6. The interim report released by the Aged Care Royal
Commission specified regular, targeted reviews conducted by
which healthcare professional as an evidence-based method of
reducing psychotropic use?
A) Geriatricians.
B) Nurse practitioners.
C) Accredited consultant pharmacists.
D) Psychologists.
5. Federal Register of Legislation. Quality of Care Principles 2014. Available from:
https://www.legislation.gov.au/Details/F2020C00096.
6. Burns K, Jayasinha R, Tsang R, Brodaty H. ‘Behaviour management: A guide to
good practice’. Dementia Collaborative Research Centre, 2012.
7. Brice JH, Pirrallo RG, Racht E, Zachariah BS, Krohmer J. ‘Management of the
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8. Tasmanian government Department of Health. CFP Clinical Guideline 10:
Chemical Restraint. 2017. Available from: https://www.dhhs.tas.gov.au/__data/
assets/pdf_file/0004/252769/CFP_Clinical_Guideline_10_-_Chemical_
Restraint.pdf.
9. Brown L, Hansnata E, Anh La H. ‘The economic cost of dementia in Australia:
2016 to 2056’. Canberra: The Institute for Governance and Policy Analysis, 2017.
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AGE 70. Canberra: AIHW.
11. Colombo M, Vitali S, Cairati M, Vaccaro R, Andreoni G, Guaita A. ‘Behavioral and
psychotic symptoms of dementia (BPSD) improvements in a special care unit: a
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12. Macfarlane S, O’Connor D. ‘Managing behavioural and psychological symptoms
in dementia’.
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, 2016; 39 (4): 123-5.
13. Byrne GJ. ‘Pharmacological treatment of behavioural problems in dementia’.
Aust Prescr
, 2005; 28 (3): 67-70.
14. Royal Australian and New Zealand College of Psychiatrists. Antipsychotic
medications as a treatment of behavioural and psychological symptoms of
dementia (Professional Practice Guideline 10). Aug 2016. Available from: https://
www.ranzcp.org/Files/Resources/College_Statements/Practice_Guidelines/
pg10-pdf.aspx.
15. O’Neil ME, Freeman M, Christensen V, Telerant R, Addleman A, Kansagara D.
VA Evidence-based Synthesis Program Reports. A Systematic Evidence Review
of Non-pharmacological Interventions for Behavioral Symptoms of Dementia.
Washington (DC): Department of Veterans Affairs; 2011.
16. Westbury JL, Gee P, Ling T, Brown DT, Franks KH, Bindoff I, et al. ‘RedUSe:
reducing antipsychotic and benzodiazepine prescribing in residential aged care
facilities’.
The Medic Journ Aust
, 2018; 208 (9): 398-403.
17. Van der Spek K, Gerritsen DL, Smalbrugge M, Nelissen-Vrancken MH, Wetzels
RB, Smeets CH, et al. Only 10% of the psychotropic drug use for neuropsychiatric
symptoms in patients with dementia is fully appropriate. The PROPER I-study.
International psychogeriatrics. 2016;28(10):1589-95.
18. Ballard CG, Waite J, Birks J. ‘Atypical antipsychotics for aggression and
psychosis in Alzheimer’s disease’.
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Handbook Pty Ltd; 2020 January. Available from: https://amhonline.amh.net.au/.
20. Taipale H, Tolppanen AM, Koponen M, Tanskanen A, Lavikainen P, Sund R,
et al. ‘Risk of pneumonia associated with incident benzodiazepine use among
community-dwelling adults with Alzheimer’s disease’.
CMAJ: Canadian Medical
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, 2017; 189
(14): E519-e29.
21. Lonergan E, Luxenberg J, Colford J. ‘Haloperidol for agitation in dementia’.
Cochrane Database of Systematic Reviews
, 2002 (2): Cd002852.
22. Johnell K, Jonasdottir Bergman G, Fastbom J, Danielsson B, Borg N, Salmi
P. ‘Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality
among older adults’.
Internat Journ Geriat Psych
, 2017; 32 (4): 414-20.
23. Pharmaceutical Benefits Scheme. Risperidone [Internet]. Australian government
Department of Health [cited 2020 March 03]. Available from: http://www.pbs.gov.
au/medicine/item/11869Q-11872W-11873X-11874Y-11877D-11879F-11881H-11882J-
1842Y-1846E-3169T-3170W-3171X-3172Y-8100H-8780D-8781E-8782F-8787L-8789N-
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24. eTG complete [Internet]. Melbourne: Therapeutic Guidelines Ltd, 2019.
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26. Seitz DP, Adunuri N, Gill SS, Gruneir A, Herrmann N, Rochon P. ‘Antidepressants
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27. Baillon SF, Narayana U, Luxenberg JS, Clifton AV. ‘Valproate
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2
CPD CREDITS