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The Aged Care QI Program: Medication Management (Polypharmacy and Antipsychotics)

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Published: 23 November 2021

A report from the Pharmaceutical Society of Australia in 2020 found that 95% of Australian aged care residents were experiencing at least one problem with their medicines. Furthermore, over half of all aged care residents were found to have been prescribed potentially inappropriate medicines (PSA 2020).

Older adults often need to take a variety of medicines due to age-related chronic illness, with about 80% of people over the age of 65 having at least one chronic condition (ACSQHC 2021). However, the physiological processes of ageing make older people more sensitive to the effects of medicines and cause their bodies to respond differently, increasing their risk of experiencing adverse events and interactions (PSA 2020).

Inappropriate medicine use has the potential to cause a variety of negative health outcomes including falls, admission to hospital, adverse drug reactions and even mortality, yet, inappropriate prescribing continues to be a widespread and complicated issue in residential aged care (ACQSC 2020).

In order to address this issue and improve the quality of care for older adults, The National Aged Care Mandatory Quality Indicator Program (QI Program) introduced a new quality indicator on 1 July 2021 requiring all government-subsidised residential aged care providers to collect and report data on two significant aspects of medication management: polypharmacy and antipsychotics (Pozydajew 2021; DoH 2021).

Polypharmacy

qi program medication management polypharmacy
Under the QI Program, polypharmacy is defined as the prescription of nine or more medicines to a single care recipient.

Polypharmacy is common among older adults, with two-thirds of people aged over 75 taking five or more medicines simultaneously (ACSQHC 2021).

While polypharmacy is necessary in some cases, it carries significant risks and has been associated with serious consequences, including:

  • Delirium
  • Falls
  • Reduced quality of life
  • Adverse drug reactions
  • Medicine interactions
  • Medication errors
  • Cognitive decline
  • Admission to hospital
  • Premature illness or death.

(ACSQHC 2021; DoH 2021)

Polypharmacy in the QI Program

Under the QI Program, polypharmacy is defined as the prescription of nine or more medicines to a single care recipient (DoH 2021).

The medicines included in this count are all medicines (both prescription and non-prescription) with an active ingredient, except for:

  • Lotions, creams and ointments used for skin and wound care
  • Dietary supplements, including vitamins
  • Short-term medicines (e.g. antibiotics, temporary eye drops)
  • PRN medicines
  • Different dosages of the same medicine.

(DoH 2021)

Under the QI Program, residential aged care providers must collect and report data on the number of residents who have been prescribed nine or more medicines (DoH 2021).

This data collection must take place on a single collection date every quarter (DoH 2021).

Providers must review the medication charts and/or administration records of all care recipients and report the following information:

  • The data collection date for the quarter
  • The number of care recipients whose records were assessed for polypharmacy
  • The number of care recipients excluded because they were admitted to hospital on the date of data collection
  • The number of care recipients who have been prescribed nine or more medicines.

(DoH 2021)

Antipsychotics

Antipsychotics are a type of medicine intended to treat diagnosed psychosis (e.g. schizophrenia bipolar disorder, Huntington’s chorea, delusions and hallucinations, psychosis while receiving end-of-life care) (DoH 2021).

Despite this, many aged care residents are prescribed antipsychotics in order to manage behavioural and psychological symptoms of dementia (BPSD), despite this practice being contraindicated due to evidence of harm (ACQSC 2020; DoH 2020).

About one in five aged care residents are taking antipsychotics. Many of these people are also taking high doses for a longer period of time than recommended (PSA 2021; ACQSC 2020).

As well as being potentially harmful, antipsychotics are also unlikely to result in significant benefits when used to manage BPSD (Welberry et al. 2021).

The Department of Health (2020) states that antipsychotics should be prescribed as the exception, not the norm. Even in cases where antipsychotics are indicated, most people benefit from short-term use only (PSA 2021).

The use of antipsychotics in older adults may be associated with adverse effects such as:

  • Drowsiness or over-sedation
  • Confusion
  • Dizziness
  • Falls
  • Delirium
  • Increased risk of being admitted to hospital for hip fracture or pneumonia
  • Reduced quality of life
  • Stroke
  • Death.

(ACSQHC 2021; PSA 2021; ACQSC 2020)

qi program medication management sad resident
Inappropriate antipsychotic use can cause reduced quality of life as well as other adverse effects.

Antipsychotics in the QI Program

Under the QI Program, residential aged care providers must collect and report data on the number of residents who have received antipsychotics (DoH 2021).

The provider must identify a data collection date every quarter. The collection date, and the six days prior to that date, form the seven-day assessment period during which the medication charts and administration records for all care recipients must be assessed for antipsychotics (DoH 2021).

Providers must collect and report the following information:

  • The data collection date for the quarter
  • The number of care recipients whose records were assessed for antipsychotics
  • The number of care recipients excluded because they were admitted to hospital for the entire seven-day assessment period
  • The number of care recipients who received antipsychotics during the quarter
  • The number of care recipients who received antipsychotics for medically diagnosed psychosis.

(DoH 2021)

Additional Resources


References

Test Your Knowledge

Question 1 of 3

True or false: It’s appropriate to prescribe antipsychotics to manage behavioural and psychological symptoms of dementia (BPSD).

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