Set up processes to conduct and document medication reviews
Ensure medication reviews are prioritised for people with intellectual disability, given the higher risk of adverse medication events.
Require high-priority treatment when a person at substantial risk is identified in the risk assessment for a medication review. In these cases, the medication review should be documented and the prioritisation policy monitored for quality improvement purposes.[66] The NSQHS Standards include further information on conducting structured medication reviews.
Make reasonable adjustment to medication reviews
Reasonable adjustments to support the person’s involvement in a medication review include making adjustments to communication approaches and gaining knowledge of the person’s decision-making capacity. The person’s family, supporters or guardian may be able to provide history and other relevant details to support the medication review.
Assess individual risks
Put processes in place to identify and prevent potential medication-related harm, and to make sure these processes consider additional risks such as:
- Age over 65 years
- Use of high-risk medicines
- Obesity
- Multiple prescribers
- Multiple comorbidities
- Impaired hepatic or renal function
- Taking more than five regular medicines (including over-the-counter and complementary medicines).
For people with intellectual disability the above risks may be amplified as a result of:
- The person’s communication abilities
- The health literacy or understanding of the person supporting them
- The capacity of the person and the level of support and assistance the person needs to understand and manage their medications safely.
Promote best practice prescribing
Promote best practice in prescribing and reviewing inappropriate prescribing. This includes using an evidence-based deprescribing process in which the prescribing review identifies medicines that are no longer required or are inappropriate, or where the harms outweigh the benefits.63,64,[67]
People with intellectual disability have been shown to be at higher risk of being inappropriately prescribed antipsychotics, particularly when the medication is used to control their behaviour. It is critical that if medicines are deprescribed (or prescribed), the rationale and protocol for deprescribing is documented in the discharge summary. Deprescribing can often involve prolonged weaning or tapering regimens, which should be communicated at transition of care.
Any change to a person’s medicine regimen should first be discussed with the person and their family, supporters or guardian, to explain why the change may be necessary, including the risks and benefits. Informed consent is required. The person may have a formal or informal support network for assistance in their home, so it is important to ensure these supporters are aware of the change and why it was made.
If a new medicine is prescribed, ensure the patient receives relevant information about the new medicine in an accessible format, including information about potential side effects and when to seek support if required.
