The Society of Hospital Pharmacists of Australia
Recommendations from The Society of Hospital Pharmacists of Australia on end-of-life care, antibiotics, antipsychotic drugs, NSAIDs & codeine. The Society of Hospital Pharmacists of Australia (SHPA) is the national professional organisation for more than 3,000 pharmacists, pharmacists in training, pharmacy technicians and associates working across Australia’s health system.
Don’t initiate and continue antipsychotic medicines for behavioural and psychological symptoms of dementia for more than 3 months.
Behavioural and psychological symptoms of dementia (BPSD) are often temporary. The mainstay treatment of BPSD is non-pharmacological. Antipsychotic medicines should only be considered when non-pharmacological interventions have failed and the patient has symptoms that are distressing for them, their family or co-residents.
Patients or their carer, or designated guardian, should be involved in the decision to begin treatment with an antipsychotic medicine. Consideration needs to be given to the patient’s ability to appreciate the consequences of refusing, or agreeing to, treatment.
If used, the dose of the antipsychotic medicine should be increased as slowly as necessary with the goal of using the lowest effective dose for the shortest possible time. The effectiveness of the medicine and the occurrence of delirium, sedation, or anti-cholinergic side effects should be assessed at least weekly.
Treatment should be reviewed after no more than 3 months and the dose should be reduced and then stopped wherever possible.
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- Westbury J, Beld K, Jackson S, Peterson GM. Review of psychotropic medication in Tasmanian residential aged care facilities. Australasian Journal on Ageing 2010;29(2):72-6.
- Snowdon J, Galanos D, Vaswani D. Patterns of psychotropic medication use in nursing homes: surveys in Sydney, allowing comparisons over time and between countries. International Psychogeriatrics 2011;23(9):520-1525.
- Ballard CG, Waite J, Birks J. Atypical antipsychotics for aggression and psychosis in Alzheimer’s disease. Cochrane Database of Syst Rev. 2006, Issue 1 CD003476.
- Liperoti R, Pedone C, Corsonello A. Antipsychotics for the treatment of behavioral and psychological symptoms of dementia (BPSD). Curr Neuropharmacol 2008; 6(2): 117-24.
- Gareri P, De Fazio P, Graziella V, Manfredi L, De Sarro G. Use and safety of antipsychotics in behavioral disorders in elderly people with dementia. J Clin Psychopharmacol 2014;34:109-3.
- Psychotropic Expert Groups. Therapeutic guidelines: psychotropic. Version 7. Melbourne: Therapeutic Guidelines Limited; 2013.
A working party was formed and they sought suggestions from SHPA’s Committees of Specialty Practice, Reference Groups, State and Territory branches and Federal Council. More than 40 proposed statements were considered by the working party. A shortlist of 10 statements was identified for consideration by the SHPA’s membership through an online survey. All members were invited to comment on each proposed statement, specifically: whether it related to the practice of pharmacy, related to medicines that are frequently used, and if a significant cost. Members were also invited to rate the statements in order of preference. The survey results were used by the working party to identify the final six statements which were presented to SHPA’s Federal Council who ratified the choice of the five final statements.
- 1 Don’t initiate and continue medicines for primary prevention in individuals who have a limited life expectancy.
- 2 Don’t initiate an antibiotic without an identified indication and a predetermined length of treatment or review date.
- 3 Don’t initiate and continue antipsychotic medicines for behavioural and psychological symptoms of dementia for more than 3 months.
- 4 Don’t recommend the regular use of oral non-steroidal anti-inflammatory medicines (NSAIDs) in older people.
- 5 Don't recommend the use of medicines with sub-therapeutic doses of codeine (<30mg for adults) for mild to moderate pain.