Choosing Antipsychotics Wisely

Choosing Antipsychotics Wisely

Since the recommendations from the Australian Aged Care Royal Commission to reduce prescribing of antipsychotics in Residential Aged Care Facilities (RACFs) and Pharmaceutical Benefit Scheme (PBS) strict clinical criteria, there has been limited published data on antipsychotic prescribing in people who present to hospital particularly with dementia or delirium. West Moreton Health undertook a Choosing Antipsychotic Wisely project that investigated antipsychotic prescribing in people with dementia or delirium on admission, during their stay and upon discharge.

Evaluating antipsychotic use at West Moreton Health

They audited a sample of 141 patients, 65 years or over (over 45 years for indigenous peoples) with dementia or delirium, without severe mental illness, prescribed antipsychotics

The audit highlighted several implications for persons with dementia or delirium admitted to hospital:

1. High rate of antipsychotics prescribed for changed behaviours, frequently as first-line treatment
   Over a third of patients (n=49, 35%) were prescribed antipsychotics prior to admission, with 103 (73%) prescribed a new antipsychotic in hospital. Under half (n=68, 48%) had documented evidence of non-pharmacological interventions as first-line management.
2. Limited evidence of regular review of antipsychotic treatment
   Only 29% (n=30) of patients prescribed antipsychotics in hospital had documentation of a review of antipsychotic treatment.
3. Limited antipsychotics management plans on discharge
   Sixty- eight patients (48%) were discharged with antipsychotics; however, only 4% (n=6) were provided an antipsychotic management plan in their discharge summary

The response - Antipsychotic stewardship

Following this study, WMH have designed a blueprint for antipsychotic stewardship initiatives to reduce antipsychotic treatment during admission and discharge for those with dementia and delirium. They are aiming to implement strategies within the following domains.

1. Design and implement hospital-wide educational initiatives
   a. Outline and standardize best practice for antipsychotic prescribing and consent
   b. Target a multidisciplinary audience to foster culture change
   c. Encourage daily discussions of antipsychotic prescribing on rounds
2. Leverage the digital electronic prescribing
   a. Create an antipsychotic stewardship dashboard with real-time data on prescribing
3. Audit and feedback on prescribing practices
   a. Engage senior leadership with real-time data on prescribing patterns

Working together to improve the care of people with dementia

Successful antipsychotic stewardship interventions require a multifaceted approach involving a combination of these strategies.

This Choosing Wisely program is taking steps to improve care for people with dementia.

CWA champion health services can adopt and implement Choosing Antipsychotics Wisely.

Tumusiime, W. A., Hardman, C. J., & Breen, J. L. (2022). Antipsychotic prescribing in people admitted to hospital with dementia or delirium. Australasian journal on ageing, 41(2), 258–264. https://doi.org/10.1111/ajag.1...