Aims
Older adults living with cognitive impairment are at heightened risk for developing delirium or behavioral and psychological symptoms of dementia. Whilst the preferred management of these behaviours are non-pharmacological strategies, psychotropic medications are often utilized. These medications are classified as chemical restraints when prescribed to manage behavioral symptoms, necessitating informed consent from the patient or a substitute decision-maker as per Australian regulations. The recently released Clinical Care Standard for Psychotropic Medicines in Cognitive Disability or Impairment emphasises the importance of this practice.
Methods
This retrospective chart audit, conducted at a tertiary Australian hospital, examined compliance with informed consent requirements for psychotropic prescriptions in inpatients diagnosed with delirium and/or dementia. Additionally, it assessed the review of newly initiated psychotropic medications and the documentation of follow-up plans in discharge summaries. The study reviewed medical records of 100 consecutive patients aged 65 years and older admitted under general medicine or geriatrics teams.
Results
Findings revealed that 64% of patients had at least one psychotropic medication prescribed during admission. Risperidone was the most frequently prescribed drug. Informed consent was documented in only 26.9% of cases. Furthermore, discharge documentation was inconsistent, with only 30% of required follow-up plans recorded for patients prescribed psychotropics at discharge.
Conclusions
This audit highlights substantial gaps in adherence to Australian healthcare standards concerning psychotropic prescription and informed consent. The findings underscore the need for policy improvements and enhanced clinical protocols to ensure safe and ethical psychotropic use in hospitalized older adults with cognitive impairment.