Medications and the Restrictive Intervention Database ...



|Medications and the Restrictive Intervention Database System (RIDS): Guide – January 2016 |

|Office of Professional Practice, Senior Practitioner - Disability |

Contents

Who is this document for 1

Introduction 1

What type of medication is it? 2

Antipsychotic 2

Benzodiazepine 2

Mood Stabilisers (also known as an anticonvulsant) 2

Antidepressants 2

Hormonal 2

How to determine whether the medication use is a chemical restraint 3

Appendix 1 5

Antipsychotics 5

Psychostimulants 5

Menstrual suppression 5

Antiandrogen and hormonal 6

Anticholinergic 6

Benzodiazepines 6

Sedative 7

Antidepressants 7

Mood stabilisers 8

Who is this document for

|This document is for? |What is important? |Actions required |

|Authorised Program Officer |All |Approve as Restrictive Interventions (chemical restraint) |

|Disability Service Provider |All |Ensure compliance with reporting on RIDS |

|Direct support workers |All |For information and to ensure compliance and understanding |

Introduction

The following guide and the medication list have been written to answer the most frequently asked questions by disability service providers. The reporting of chemical restraint on the Restrictive Intervention Data System (RIDS) is a requirement of the Disability Act 2006.

The Disability Act states that:

• the Senior Practitioner is generally responsible for ensuring that the rights of persons who are subject to restrictive interventions and compulsory treatment are protected and that appropriate standards in relation to restrictive interventions and compulsory treatment are complied with;’ (section 23.2(a)).

This includes chemical restraint as defined in the Act:

• ‘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’.

For further information contact: The Office Professional Practice /Senior Practitioner Disability on (03) 90968427 or email office of professionalpractice@dhhs..au

Ensure all staff are aware of the side effects of all the medications a person in their care is taking. (Product information can be obtained from your local pharmacist).

What type of medication is it?

Antipsychotic

This is a group of medications used in the treatment of psychosis. They can reduce or eliminate delusions, hallucinations and thought disorders.

Benzodiazepine

This is a group of medications depress the central nervous system and have a calming sleep promoting or sedating effect. They can be used to manage side effects of other medications, to manage seizures, short term treatment to manage anxiety disorders and sleep disturbance.

Mood Stabilisers (also known as an anticonvulsant)

This is a group of medications used in the treatment of mood disorders such as depression and bi-polar illness. They are also used to treat seizures and seizure disorder such as epilepsy. Some of the medications used to treat epilepsy may have a mood stabilising effect.

Antidepressants

This is a group of medications used to treat depression, some may also assist in managing anxiety or obsessive compulsive disorder and others may help when sleep disturbance is also experienced with depression.

Men - This group of medications may be given as a means of deliberately reducing sexual arousal.

Hormonal

Women - This is a group of medications used to treat a range of gynecological issues. They may be used for contraception i.e. IUD (inter uterine device). They may also be used for menstrual suppression, (to stop her period).

Men - This group of medications may be given as a means of deliberately reducing sexual arousal.

How to determine whether the medication use is a chemical restraint

Sometimes, it is difficult for disability services to clearly determine when the use of a prescribed medication is a chemical restraint. The Senior Practitioner-Disability office’s practitioners have developed the following questions to assist service providers’ understanding of when a chemical restraint has occurred.

|Helpful question |Answer |Action |

|Does the person have a diagnosis of mental illness|Yes |Do not report on RIDS if this medication is for the treatment of their mental |

|in writing signed by a medical practitioner, | |illness. |

|psychiatrist or General Practitioner (GP) | |Ensure that this person & their medications and monitored by a Medical Practitioner |

|prescribed for treatment of this mental illness? | |(MP). |

| | |If the person has any behaviours of concern develop a Behaviour Support Plan (BSP), |

| | |this will assist consistency and monitoring of interventions for the person. |

| |No |Develop a Behaviour Support Plan (BSP) and report on RIDS. |

| | |Discuss with the Medication Practitioner if a referral to a specialist is required |

| | |for diagnosis and medication review. |

| | |Continue the medication reviews by a Medical Practitioner on an annual basis or |

| | |before if necessary. |

The community norm is that a General Practitioner (GP) may diagnose and treat some psychiatric conditions; however the complexities of the person’s disability may require specialist knowledge.

The Senior Practitioner - Disability is recommending anyone who is taking psychotropic medications should be receiving regular comprehensive reviews by a registered Medical Practitioner (MP).

|Helpful question |Answer |Action |

|Is the medication prescribed for the treatment of |Yes |Do not report on RIDS if this medication is for treatment of a medical condition; |

|a physical condition such as epilepsy? (ask their | |ensure regular review by a Medical Practitioner, referral to a specialist may be |

|treating doctor) | |necessary. |

| |No |Develop a Behaviour Support Plan (BSP) and report on RIDS. |

| | |Discuss with the General Practitioner if a referral to a Medical Practitioner for |

| | |diagnosis and medication review is appropriate. |

| | |Continue the medication reviews on an annual basis or before if necessary. |

|Helpful question |Answer |Action |

|Is the medication only given for sedation to |Yes |Do not report on RIDS this is to enable the treatment of the person with a disability|

|enable a medical or dental procedure and not for | | |

|sedation at any other time? | | |

| |No |Develop a Behaviour Support Plan (BSP) and report on RIDS |

| | |Continue the medication reviews on an annual basis or before if necessary. |

|Helpful question |Answer |Action |

|Does the woman have a medical condition diagnosed |Yes |Do not report on RIDS this is for treatment of a medical condition |

|by a registered medical practitioner? | | |

| |No |Develop a Behaviour Support Plan (BSP) and report on RIDS |

| | |Ask General Practitioner for a referral to a Registered Medical Practitioner for |

| | |diagnosis and medication review. |

|Helpful question |Answer |Action |

|Does the man have a history of problematic sexual |Yes |Develop a Behaviour Support Plan (BSP) and report on RIDS |

|behaviours? Is the medication prescribed to reduce| |Contact our office on 90968427, contact the Centre for Forensic Dual Disability Service|

|his sexual arousal and associated behaviour? | |on and follow this hyperlink to our practice guide |

| | |

| | |e/our-groups/office-of-professional-practice/research-and-evaluation-opp/senior-practit|

| | |ioner-disability-anti-libidinal-medication-use/Anti-libidinal-medication-use-in-people-|

| | |with-intellectual-disability.pdf |

| | |Please note: anti libidinal agents should only be used as an adjunct to psychological |

| | |treatment. They carry a significant side effect profile and are subject to strict pre |

| | |testing and on-going monitoring. |

| |No |If he has problematic sexual behaviours but isn’t on medication. You might need support|

| | |to understand the nature of the problem and how to manage the behaviour in the least |

| | |restrictive way. |

Appendix 1

Antipsychotics

Effective in eliminating or reducing psychotic symptoms such as delusions, hallucinations and thought disorders.

|Type of medication |Generic names |Product name |

|Typical antipsychotic medications: older style |Chlorpromazine |Largactil |

|medications | | |

| |Haloperidol |Serenace |

| |Pericyazine |Neulactil |

| |Trifluoperazine hydrochloride |Stelazine |

|Atypical antipsychotic medications: newer style |Amisulpride |Solian Tablets and Solution |

|medications | | |

| |Aripiprazole |Abilify |

| |Olanzapine |Zyprexa, |

| | |Zyprexa IM |

| |Quetiapine fumarate |Seroquel |

| |Risperidone |Risperdal |

| |Ziprasidone |Geodan |

| |Paliperidone |Invega Prolonged release tablets |

| |Asenapine Maleate |Saphris Wafer |

Psychostimulants

Medications used to suppress overactive behaviour

|Type of medication |Generic names |Product name |

|Other central nervous systems agents |Atomoxetine hydrochloride |Strattera |

| |Dexamphetamine sulfate |Dexamphetamine Tablets |

| |Lisdexamfetamine dimesilate |Vyvanse |

| |Methylphenidatehydrochloride |Ritalin 10 |

| | |Ritalin LA” |

| | |Attenta Concerta Extended-Release Tablet |

Menstrual suppression

Medications used to stop women having their menstrual cycle

|Type of medication |Generic names |Product name |

|Gonadal Hormones |Medroxyprogesterone acetate |Depo-Provera Depo-Ralovera Provera |

| |Norethisterone |Primolut N |

| |Oestrogens, conjugated |Premarin Tablets |

|Combined oral contraceptive agents |Mestranol |Norinyl-1 |

Antiandrogen and hormonal

Medications used to suppress libido

|Type of medication |Generic names |Product name |

|Gonadal Hormones |Cyproterone acetate |Androcur |

| | |Cyprone |

| | |Procur |

| | |Diane-35 ED (others also have a women’s name and |

| | |35) |

|Combined oral contraceptive agents |Ethinyloestradiol |Brevinor |

| | |Brevinor-1 |

| | |Synphasic” |

| | |Levlen ED |

| | |Microgynon 30 |

| | |Microgynon 30 ED |

| | |Microgynon 50 ED |

Anticholinergic

Medications used to treat side effects caused by antipsychotic medications

|Type of medication |Generic names |Product name |

|Movement disorders |Benzhexol hydrochloride |Artane |

| |Benztropine mesylate |Benztrop |

| | |Cogentin |

| |Biperiden hydrochloride |Akineton |

Benzodiazepines

Medications that depress the central nervous system and have a calming sleep promoting effect

|Type of medication |Generic names |Product name |

|Antianxiety agents |Alprazolam |Alprax |

| | |Alprazolam-DP |

| | |Kalma |

| | |Xanax |

| |Clobazam |Frisium |

| |Diazepam |Antenex |

| | |DiazepamElixir10mg/10ml |

| | |Diazepam-DP |

| | |Ducene |

| | |Valium |

| | |Valpam |

| |Lorazepam |Ativan |

| |Oxazepam |Alepam |

| | |Murelax |

| | |Serepax |

|Anticonvulsants |Clonazepam |Paxam |

| | |Rivotril |

|Sedatives, hypnotics |Nitrazepam |Alodorm |

| | |Mogadon |

| |Temazepam |Normison |

| | |Temaze |

| | |Temtabs |

| |Zopiclone |Imovane |

Sedative

Medications used to promote sleep

|Type of medication |Generic names |Product name |

|Other central nervous system agents |Melatonin |Melatonin |

Antidepressants

Medications used in the treatment of depression and other mood disorders such as bi-polar illness

|Type of medication |Generic names |Product name |

| |Paroxetine hydrochloride |Aropax |

| | |Extine |

| | |Paroxetine-DZ |

| | |Paxtine |

| |Sertraline hydrochloride |Zoloft |

| | |Concorz |

| | |Eleva |

| | |Sertraline Winthrop |

| | |Sertraline-DP |

| | |Xydep |

| |Amitriptyline hydrochloride |Endep |

| |Citalopram hydrobromide |Celapram |

| | |Cipramil |

| | |Citalopram Winthrop |

| | |Talam |

| | |Talohexal |

| |Clomipramine hydrochloride |Anafranil |

| | |Placil |

| |Desvenlafaxine |Pristiq extended release tablets |

| |Dothiepin hydrochloride |Dothep |

| |Dothiepin |Dothep |

| | |Prothiaden |

| |Doxepin hydrochloride |Deptran |

| | |Sinequan |

| |Duloxetine |Andepra Capsules |

| |Escitalopram oxalate |Esipram |

| | |Lexapro |

| |Fluvoxamine maleate |Faverin |

| | |Luvox |

| | |Movox |

| | |Voxam |

| |Fluoxetine |Fluoxetine-DP |

| | |Lovan |

| | |Prozac |

| | |Zactin |

| |Mirtazapine |Avanza |

| | |Avanza SolTab |

| | |Axit |

| | |Mirtazapine-DP |

| | |Mirtazon |

| |Moclobemide |Amira |

| | |Arima |

| | |Aurorix |

| | |Clobemix |

| |Venaflaxine |Efexor |

| | |Efexor-XR |

Mood stabilisers

Medications effective in mood disorders such as depression or bi-polar illness/some medications used for the treatment of epilepsy have a mood stabilising effect

|Type of medication |Generic names |Product name |

|Anticonvulsants |Carbamazepine |Carbamazepine Sandoz Carbamazepine-BC |

| | |Tegretol |

| | |Teril |

| |Gabapentin |Gabahexal |

| | |Neurontin |

| |Phenytoin sodium |Dilantin |

| |Lacosamide |Vimpat |

| |Lamotrigine |Lamictal |

| | |Lamogine |

| | |Lamotrigine-DP |

| | |Seaze |

| |Levetiracetam |Keppra |

| |Oxcarbazepine |Trieptal Oral suspension |

| |Sodium Valproate |Epilim |

| | |Valpro |

| |Topiramate |Topamax |

|Antipsychotic agents |Lithium carbonate |Lithicarb |

| | |Quilonum SR |

|To receive this publication in an accessible format phone 9096 1903, using the National Relay Service 13 36 77 if required, or email |

|RIquestions@DHHS..au |

|Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. |

|© State of Victoria, Department of Health and Human Services September 2016 |

|ISBN/ISSN ISBN 978-0-7311-7072-2 (pdf) |

|Available at |

|Office of Professional Practice – |

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