The following has been reviewed based on the clinical and policy information you have provided us:

 Psychotropic Medications

Behavioural and psychological symptoms in people living with dementia (BPSD) should first be addressed through non-pharmacological means, with emphasis on comprehensive assessment, addressing unmet needs and supporting the person and their family and carers.

For this audit, Psychotropic medications are ‘any drug capable of affecting the mind, emotions, and behaviour.’ The three main classes of psychotropics prescribed are:

• Antipsychotics
• Antidepressants
• Anxiolytic /hypnotics (mostly benzodiazepines to manage anxiety and insomnia)
• Anticonvulsants
• Anti-dementia medications
• Opioids

Psychotropics should only be prescribed after medical assessment of specific symptoms or diagnosis which requires the management of specific medical needs such as Epilepsy, Pain, DSM 5 Mental Health Conditions (excluding dementia) and sleep disorders.  When psychotropic medication is used to manage behaviour, it may be classed as chemical restraint. As such, we review this medication in alignment with diagnosis and other information such as if the person is receiving support from mental health teams, is on decreasing medication regimes or has complex needs. This includes (but is not limited to) people who have a diagnosis of:

• Depression
• Insomnia
• Bipolar
• Anxiety
• Schizophrenia
• Delusional disorders

Care plans

Care plans have been reviewed against the following criteria:

• Is the use of language person centred?
• Is the care plan written from a strengths-based perspective for the person or is the care plan more focussed on deficits?
• Is their use of any labelling language?
• Do the interventions reflect individuality or are they written in a generic way?
• Does the care plan include elements beyond clinical needs and deficits? For example, does this include a holistic framework which gives a sense of who the person is and how best to connect with the person from a social, care and well-being perspective?
• Where the care plan refers to ‘Behaviours’ are these communicated as an expression of unmet need or identified as a challenge? Furthermore, does the care plan identify potential trigger sources and describe how to support the person to move from a state of ill-being to a state of well-being.

Policy Review

Any policy documents you have provided us are reviewed against the following criteria:

• Is the policy written to reflect not only regulations but take into consideration the elements of person centredness as outlined by Kitwood?
• Is the policy and procedure reinforcing a task-based culture – if so, how could this be potentially improved?
• What are positive elements of the policy?
• What are areas for improvement to ensure congruence with the person-centred framework of the home?