This audit is relevant to any setting where medication is prescribed to manage behavioural problems in adults with intellectual disabilities.
Deb & Fraser (1994) estimated that 20–45% of people with intellectual disabilities take psychotropic medications, of whom 14–30% take them to control a behavioural problem such as aggression or self-injurious behaviour. Clarke et al (1990) reported that 36% of people with intellectual disabilities in residential settings are prescribed psychotropic medications in the absence of a diagnosed psychiatric illness. The aim of the audit was to investigate the practice and subsequent documentation of the use of medication in this context, as controversy surrounds it and there is a paucity of evidence of its effectiveness.
The standards were derived from a national guideline document (Deb et al, 2006):
ᐅ The prescriber needs to ensure that an assessment has been conducted and recorded before treatment is begun.
ᐅ The prescriber is responsible for assessing the person's capacity to consent to treatment.
ᐅ The prescriber should provide the person and/or carers with a written treatment plan at the time of prescribing. The prescriber should also discuss with the person and/or carers the common and serious adverse events related to the treatment (where possible, the prescriber should provide accessible information in writing).
ᐅ The method and timing of the assessment of outcome should be set at the beginning of the treatment, along with a follow-up date of review. As far as possible, there should be an objective way to assess outcome (the use of standardised scales is recommended).
ᐅ As far as possible, only one medication should be used at a time, within the recommended range of doses set out in the British National Formulary (BNF) (Joint Formulary Committee, 2009).
Investigators identified a list of all patients who were prescribed medication for a behavioural problem within the past 3 years. This may require investigation into the case notes of each patient within a clinic to establish the reason for any prescriptions. Cases where medication had been prescribed primarily for a mental illness, epilepsy, substance misuse or brain injury were excluded.