Dr Edward Theologis - Austin Health Brain Disorders Program Victoria - The Responsible & Rationale Use of Medication for Behaviour Control (Chemical Restraint) in Young People with Brain Injury
Upcoming SlideShare
Loading in...5
×
 

Dr Edward Theologis - Austin Health Brain Disorders Program Victoria - The Responsible & Rationale Use of Medication for Behaviour Control (Chemical Restraint) in Young People with Brain Injury

on

  • 296 views

Edward Theologis delivered the presentation at the 2014 Younger People with very High & Complex Care Needs Conference. ...

Edward Theologis delivered the presentation at the 2014 Younger People with very High & Complex Care Needs Conference.

The 4th Annual Younger People with very High & Complex Care Needs Conference focused on topics such as report on Summer Foundation’s preliminary findings from NDIS Launch sites in Barwon & the Hunter Valley, identify policy & practice opportunities & barriers for YPINH that arise from the NDIS.

For more information about the event, please visit: http://www.informa.com.au/youngerpeopleconference14

Statistics

Views

Total Views
296
Views on SlideShare
295
Embed Views
1

Actions

Likes
1
Downloads
7
Comments
0

1 Embed 1

https://twitter.com 1

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Dr Edward Theologis - Austin Health Brain Disorders Program Victoria - The Responsible & Rationale Use of Medication for Behaviour Control (Chemical Restraint) in Young People with Brain Injury Dr Edward Theologis - Austin Health Brain Disorders Program Victoria - The Responsible & Rationale Use of Medication for Behaviour Control (Chemical Restraint) in Young People with Brain Injury Presentation Transcript

  • Chemical Restraint The responsible use of medication for behavioural control Dr Edward Theologis Clinical Director / Psychiatrist Brain Disorders Program Victoria (BDVP)
  • Service Components Function Location Community Team CBDATS ABIBC Outreach Functions Royal Talbot Inpatient Unit Heath Wattle-Protea Slow-stream Neuropsychiatric Rehabilitation Royal Talbot Transitional Program Step 2 House Community Reintegration Royal Talbot Outpatient Service NBC & Functional Neurology Clinic Outpatient Neuropsychiatric Assessment Repat BDPV: statewide MHS for ABI + mental illness
  • “Behaviour” medication in Health Care Antibiotics • Urinary tract infection (UTI) • Infective encephalitis Steroids • Immune encephalitis Anaesthetic drugs • Induced coma in ICU Psychotropic drugs • Clear-cut psychiatric condition (eg: psychosis, mania..) • Symptom control (eg: benzodiazepines in anxiety..) • Off-label use (eg: beta blockers in aggression..)
  • Arousal & Medications Normal
  • Arousal & Medications Agitation
  • Arousal & Medications Explosiveness
  • Arousal & Medications Explosiveness & agitation
  • Arousal & Medications Explosiveness & adynamia
  • Definition of “Chemical Restraint”
  • Definitions of Chemical Restraint Victorian Mental Health Act 2014 • No definition of chemical restraint • “Restrictive interventions” only include •  Bodily restraint •  Seclusion Commonwealth Aged Care Act 1997 • No definition of any restrictive intervention Victorian Disability Act 2006 – “Restrictive Interventions” • Chemical restraint • Mechanical restraint • Seclusion
  • Definitions – Vic Disability Act 2006 "restrictive intervention" means any intervention that is used to restrict the rights or freedom of movement of a person with a disability “chemical restraint” is the use, for the primary purpose of the behavioural control of a person with a disability, of a chemical substance to control or subdue the person but does not include the use of a drug prescribed by a registered medical practitioner for the treatment, or to enable the treatment, of a mental illness or a physical illness or physical condition (Disability Act 2006, section 3)
  • Definition – State Operations Manual USA Any drug that is used for discipline or convenience and not required to treat medical symptoms. • Discipline - refers to any action taken by the facility for the purpose of punishing or penalizing residents • Convenience - refers to any action taken by the facility to control a resident’s behaviour or manage a resident’s behaviour with a lesser amount of effort by the facility and not in the resident’s best interest • Medical Symptom - denotes an indication or characteristic of a physical or psychological condition CMS (Centers for Medicare & Medicaid Services) State Operations Manual (Internet-only Manual), Pub. 100-07 Appendix PP Guidance to Surveyors for Long Term Care Facilities, F222, §483.13(a) Restraints.
  • Chemical Restraint – elsewhere..
  • Chemical Restraint When is it a “responsible” option ?
  • “Responsible” Chemical Restraint •  When it is not “chemical restraint” •  PBS indication – the diagnosis is clear and there is strong scientific evidence for the use of a medication, such as the use of an antipsychotic in the treatment of acute psychosis •  “Off-label” use – when there is no PBS indication but scientific or other strong evidence that a drug is effective, such as the use of a mood stabilizer in an explosive frontal lobe syndrome •  Risk reduction – when there is immediate risk to self or others and other approaches are even more restrictive (such as physical restraint or seclusion) •  Specialist consultation – a specialised service is likely to have a more complete understanding of the risks vs benefits of off-label or other uses of medication to manage arousal •  Oversight and governance – when there is a presiding body to independently review quality and legislative aspects of such use of medications
  • “Irresponsible” Chemical Restraint •  Discipline - refers to any action taken by the facility for the purpose of punishing or penalizing residents •  Convenience - refers to any action taken by the facility to control a resident’s behaviour or manage a resident’s behaviour with a lesser amount of effort by the facility and not in the resident’s best interest •  Poor monitoring & safety – when there is no formal process to monitor side-effects such as gait disturbance (falls risk), endocrine irregularities, elevated serum ammonia, cardiac toxicity and respiratory depression •  Lack of policies, governance & reporting – when persons prescribing and dispensing the medications do not have clear boundaries in the use of such medications and accountability in this practice
  • Examples of Chemical Restraint Antipsychotics Mood stabilizers Antidepressants Hypnotics Beta blockers Pain killers
  • Chemical Restraint – final thoughts •  Polypharmacy does not automatically equal chemical restraint •  Oligopharmacy does not guarantee lack of chemical restraint •  Motives such as convenience and punishment are clearly red flags, but altruistic motives alone do not protect against the inappropriate use of chemical restraint •  Scientific evidence, specialist input and sound governance and reporting framework are more important in promoting “responsible” chemical restraint
  • www.bdpv.org (03) 9490 7366