Dáil Éireann Debate, Tuesday - 12 June 2018
646. Deputy Fergus O'Dowd asked the Minister for Health the national protocols in place for the administration of psychotropic drugs to patients in nursing homes and other institutions in which persons are in care; the system of monitoring and inspection in place to ensure that persons are not administered these drugs improperly or illegally; and if he will make a statement on the matter. [24505/18]
Amharc ar fhreagraThe Health Information and Quality Authority (HIQA) is the independent authority established under the Health Act 2007 to monitor safety and quality and drive continuous improvement in Ireland’s health and personal social care services. Since 2009 all nursing homes - public, voluntary and private, have been registered and inspected by HIQA. This responsibility is underpinned by a comprehensive quality framework comprising Regulations and National Standards.
The Health Act 2007 (Care & Welfare of Residents in Designated Centres for Older People) Regulations, 2013 contain provisions relating to 'Medicines and pharmaceutical services' and 'Managing behaviour that is challenging' including a requirement that where restraint is used, it is used only in accordance with national policy. All nursing homes are required to have written policies on the ordering, receipt, prescribing, storing and administration of medicines and on restraint. Providers must keep detailed records of all occasions on which restraint is used. These records must be available for examination by HIQA. The regulations require providers to notify the Chief Inspector on a quarterly basis of any occasion when restraint was used. Revised National Quality Standards for Residential care settings for Older People (2016) place a stronger focus on quality of life and a person-centred approach to the care of all residents. Standard 3.4 provides that “Each resident is protected through the residential service’s policies and procedures for medicines management” and Standard 3.5 requires providers to have in place “Arrangements to protect residents from harm, promote bodily integrity, personal liberty and a restraint-free environment in accordance with national policy”.
National policy on restraint, including chemical, physical and environmental restraint is set out in Towards a Restraint Free Environment in Nursing Homes, (2011) and is available on the Department of Health website.
The National Dementia Strategy (2014) acknowledges that in some cases the use of psychotropic medications is appropriate in conjunction with environmental interventions for the management of behavioural and psychological symptoms of dementia (BPSD). However, anti-psychotic drugs should only be used when all other non-pharmacological interventions have first been tried and exhausted. The National Dementia Strategy recommends that the HSE develop guidance material on the appropriate management of medication for people with dementia, and in particular on psychotropic medication management, with material to be made available in all relevant settings, including nursing homes. To address this action, the HSE’s National Dementia Office has convened a national interdisciplinary steering group to develop evidence-based clinical guidelines for healthcare professionals on the use of psychotropic medications in people with dementia, with a particular focus on antipsychotics. The guidelines will be submitted to the National Clinical Effectiveness Committee to be implemented as national clinical guidelines. The steering group will also develop an associated psychotropic medication audit tool and education and training materials in parallel with the clinical guidelines.
