Quality standard
Quality statement 12: Review of medication
Quality statement 12: Review of medication
Quality statement
People with a learning disability and behaviour that challenges have a multidisciplinary review of their antipsychotic medication 12 weeks after starting treatment and then at least every 6 months. [2015]
Rationale
Antipsychotics are the most frequently used drugs for people with a learning disability and behaviour that challenges, often in the absence of a diagnosis of a mental health problem. The use of antipsychotics should be limited and regular review should ensure that there is an appropriate rationale for prescribing. A full multidisciplinary review will also help to reduce prolonged use of antipsychotics and thereby potential side effects.
Quality measures
Structure
Evidence of local arrangements and written protocols to ensure that people with a learning disability and behaviour that challenges have a multidisciplinary review of their antipsychotic medication 12 weeks after starting treatment and then at least every 6 months.
Data source: Local data collection.
Process
a) Proportion of people with a learning disability and behaviour that challenges who have a multidisciplinary review of their antipsychotic medication 12 weeks after starting treatment.
Numerator – the number in the denominator who have a multidisciplinary review of their antipsychotic medication 12 weeks after starting treatment.
Denominator – the number of people with a learning disability and behaviour that challenges prescribed antipsychotic medication within the past 12 months.
Data source: Local data collection.
b) Proportion of people with a learning disability and behaviour that challenges who have a multidisciplinary review of their antipsychotic medication at least every 6 months after the first 12 weeks of treatment.
Numerator – the number in the denominator who have a multidisciplinary review of their antipsychotic medication at least every 6 months after the first 12 weeks of treatment.
Denominator – the number of people with a learning disability and behaviour that challenges prescribed antipsychotic medication within the last 12 months.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (secondary care services) ensure that systems are in place for people with a learning disability and behaviour that challenges to have a multidisciplinary review of their antipsychotic medication 12 weeks after starting treatment and then at least every 6 months.
Health and social care practitioners ensure that people with a learning disability and behaviour that challenges have a multidisciplinary review of their antipsychotic medication 12 weeks after starting treatment and then at least every 6 months.
Commissioners (clinical commissioning groups and NHS England) ensure that they commission services that provide people with a learning disability and behaviour that challenges with a multidisciplinary review of their antipsychotic medication 12 weeks after starting treatment and then at least every 6 months.
People with a learning disability and behaviour that challenges who take antipsychotic medication have their medication checked 12 weeks after they start taking it and then at least every 6 months. Their medication should be checked by a team that includes doctors, nurses and care staff. The check should include how well the medication is working (including whether it is causing any side effects) and whether the person should keep taking it. This should be explained to the person and their family or carers.
Source guidance
Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges. NICE guideline NG11 (2015), recommendations 1.8.4, 1.8.5 and 1.8.6
Definitions of terms used in this quality statement
Multidisciplinary review
A review of prescribed antipsychotic medication by a team that includes doctors, nurses and care staff that includes the following:
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a record of the extent of the response, how the behaviour has changed and any side effects or adverse events
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identification of any physical abnormalities
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the rationale for continuing the medication, if this is being done, and an explanation of this for the person with a learning disability and behaviour that challenges and everyone involved in their care, including their family members and carers.
[Adapted from NICE's guideline on challenging behaviour and learning disabilities, section 1.8]
Behaviour that challenges
Behaviour of such an intensity, frequency or duration as to threaten the quality of life and/or physical safety of the person, or others around them. It also includes behaviour that is likely to severely limit, or result in the person being denied, access to and use of ordinary community facilities.
[Adapted from NICE's guideline on learning disabilities and behaviour that challenges: service design and delivery, terms used in this guideline]
Equality and diversity considerations
The communication needs of people with a learning disability, particularly the needs of people who are unable to communicate through speech, should be taken into account in a health assessment. Practitioners may need to provide support for those who have limited speech and for those who have difficulty with English.