Background

From 1 July 2019 the NDIS Quality and Safeguards Commission will require registered service providers to report to them any use of a regulated restrictive practice.  The service provider will also need to arrange for a behaviour support plan to be developed for the person being subject to a restrictive practice.

Regulated restrictive practices include seclusion, and environmental, physical, mechanical and chemical restraint.

Chemical restraint is defined as ‘the use of medication or chemical substance for the primary purpose of influencing a person’s behaviour. It does not include the use of medication prescribed by a medical practitioner for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition’.[1]

This guideline has been developed to assist service providers to determine whether or not a medication is being prescribed for a physical condition or illness, a mental disorder or for behavioural control of the person.

It is important to note that the Tasmanian Disability Services Act 2011 does not require authorisation of the use of medication for the purposes of behaviour control.  Consent must however be obtained from the ‘person responsible’.[2]

What type of medication is it?

Anti-psychotic

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.

Anti-depressants

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 gynaecological 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.

When do I report to the Commission?

Anti-psychotic

Ask yourself

Yes

No

  • Does the person have a diagnosis of mental illness in writing signed by a medical practitioner, psychiatrist or GP prescribed for treatment of this mental illness
  • There is no need to report to the Commission if this medication   is for the treatment of their mental illness
  • Ensure that this person and their medication   are monitored by a medical practitioner, psychiatrist or GP
  • 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
  • If the behaviours of concern are new they may be a side effect of the   medication. This should be discussed with the prescriber or GP
  • Report to the Commission   & develop a BSP
  • Discuss with the GP if a   referral to a specialist is required for diagnosis and medication review
  • Continue the medication reviews by a GP on an   annual basis or before if necessary
  • Report to the Commission & develop a BSP
  • Discuss with the GP if a referral to a specialist is required for diagnosis and medication review
  • Continue the medication reviews by a GP on an annual basis or before if necessary
  • The community norm is that a GP may diagnose and treat some psychiatric conditions; however, the complexities of the person’s disability may require specialist knowledge.
  • The Senior Practitioner - Disability recommends that anyone who is taking psychotropic (anti-psychotic) medications should be receiving regular comprehensive reviews by a registered medical practitioner.

Mood Stabilisers (also know as anti-convulsants)

Ask yourself

Yes

No

  • Is the medication prescribed for the treatment of a physical condition such as epilepsy? (ask their treating doctor)
  • There is no need to report to the Commission if this medication   is for treatment of a medical condition; ensure regular review by a GP,   referral to a specialist may be necessary
  • Report to the Commission & develop a BSP
  • Discuss with the GP if a referral to a specialist   for diagnosis and medication review is appropriate
  • Continue the medication reviews on an annual   basis or before if necessary
  • Report to the Commission & develop a BSP
  • Discuss with the GP if a referral to a specialist for diagnosis and medication review is appropriate
  • Continue the medication reviews on an annual basis or before if necessary

Benzodiazepine

Ask Yourself

Yes

No

  • Is the medication only given for sedation to enable a medical or dental procedure and not for sedation at any other time?
  • There is no need to report to the Commission - this is to enable the treatment of the person with a disability
  • Report   to the Commission & develop a BSP
  • Discuss   with the GP if a referral to a specialist for diagnosis and medication review   is appropriate
  • Continue   the medication reviews on an annual basis or before if necessary

Hormonal – Women

Ask Yourself

Yes

No

  • Does the woman have a medical condition diagnosed by a registered medical practitioner?
  • There is no need to report to the Commission - this is to enable the treatment of a medical condition
  • Report   to the Commission & develop a BSP
  • Ask   GP for a referral to a specialist for diagnosis and medication review

Hormonal – Men

Ask Yourself

Yes

No

  • Does the man have a history of problematic sexual behaviours? Is the medication prescribed to reduce his sexual arousal and associated behaviour
  • Report to the Commission & develop a   BSP
  • It should be noted that 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
  • 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


Brand names of common types of medication

Please Note: The following should not be considered a definitive list and is current as at September 2016. Other generic medications and products may have entered the market since then.

Anti-Psychotics

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

Typical Anti-Psychotic Medications (Older style medications)

Generic Names

Product Name

Chlorpromazine

Largactil

Haloperidol

Serenace

Pericyazine

Neulactil

Trifluoperazine hydrochloride

Stelazine

Atypical Anti-Psychotic Medications (New style medications)

Generic Names

Product Name

Amisulpride

Solian Tablets and Solution

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 (Other central nervous systems agents)

Generic Names

Product Name

Atomoxetine hydrochloride

Strattera

Dexamphetamine sulfate

Dexamphetamine Tablets

Methylphenidatehydrochloride

Ritalin 10

Ritalin ‘LA’

Attenta Concerta Extended-Release Tablet

Anti-Cholinergic

Medications used to treat side effects caused by antipsychotic medications (movement disorders)

Generic Names

Product Name

Benzhexol hydrochloride

Artane

Benztropine mesylate

Benztrop

Cogentin

Biperiden hydrochloride

Akineton

Menstrual Supression

Medications used to stop women having their menstrual cycle

Gonadal Hormones

Generic Names

Product Name

Medroxyprogesterone acetate

Depo-Provera Depo-Ralovera Provera

Norethisterone

Primolut N

Oestrogens, conjugated

Premarin Tablets

Combined Oral Contraceptive Agents

Generic Names

Product Name

Mestranol

Norinyl-1

Anti-Androgen

Medications used to suppress libido (Gonadal Hormones)

Generic Names

Product Name

Cyproterone acetate

Androcur

Cyprone

Procur

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

Hormonal (Combined Oral Contraceptive Agents)

Generic Names

Product Name

Ethinyloestradiol

Brevinor

Brevinor-1

Synphasic”

Levlen ED

Microgynon 30

Microgynon 30 ED

Microgynon 50 ED

Anti-Depressants

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

Generic Names

Product Name

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

Paroxetine hydrochloride

Aropax

Extine

Paroxetine-DZ

Paxtine

Sertraline hydrochloride

Zoloft

Concorz

Eleva

Sertraline Winthrop

Sertraline-DP

Xydep

Venaflaxine

Efexor

Efexor-XR

Benzodiazephines

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

Anti-anxiety agents

Generic Names

Product Name

Alprazolam

Alprax

Alprazolam-DP

Kalma

Xanax

Clobazam

Frisium

Diazepam

Antenex

DiazepamElixir10mg/10ml

Diazepam-DP

Ducene

Valium

Valpam

Lorazepam

Ativan

Oxazepam

Alepam

Murelax

Serepax

Anti-convulsants

Generic Names

Product Name

Clonazepam

Paxam

Rivotril

Sedatives, Hypnotics

Generic Names

Product Name

Nitrazepam

Alodorm

Mogadon

Temazepam

Normison

Temaze

Temtabs

Zopiclone

Imovane

Sedative

Medications used to promote sleep (Other central nervous system agents)

Generic Names

Product Name

Melatonin

Melatonin

Mood Stabilizers

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 (other central nervous system agents).

Anti-convulsants

Generic Names

Product Name

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

 

Anti-Psychotic Agents

Generic Names

Product Name

Lithium carbonate

Lithicarb

Quilonum SR

Footnotes

[1] NDIS (Restrictive Practices and Behaviour Support) Rules 2018

[1] Guardianship and Administration Regulations 2017; Section 12

How do I contact the Senior Practitioner?

The Senior Practitioner is available to discuss any issues or concerns relating to the use or potential use of a restrictive intervention on the contact details listed below.

Telephone: (03) 6166 3567

Mobile: 0428 197 474

Email: mailto:seniorpractitionerdisability@communities.tas.gov.au

Senior Practitioner website

Find out more about Chemical Restraint using the RISET-Tas:

Access practice resources and restrictive intervention information via RISET-TAS online: RISET-Tas Link


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