Presentation title

Use of Medication within a Positive

Behaviour Support Framework

Presenter 1

Samantha-Louise Stallard, MSc, MBPsS, BSc (hons) Behaviour Support Advisor Dimensions Proving life can get better Mobile: 079 402 72480

Email: Samantha.stallard@dimensions-uk.org Web: www.dimensions-uk.org Twitter: www.twitter.com/dimensionsuk Address: Dimensions, Mill House Centre, Mill Road, Totton, Southampton, SO40 3AE

Presenter 2

Dave Robinson

Health and Wellbeing Programme Manager

Dimensions

Proving life can get better

Tel: 0300 303 9095 Mobile: 0777 620 8794 Email: dave.robinson@dimensions-uk.org Web: www.dimensions-uk.org Twitter: www.twitter.com/dimensionsuk

What is challenging behaviour?

“Behaviour can be described as challenging when it is of such an intensity,

frequency or duration as to threaten the quality of life and/or the physical safety

of the individual or others and is likely to lead to responses that are restrictive,

aversive or result in exclusion.”

-Emerson, E (1995)

Positive behaviour support in practice

Functional

Behaviour

Assessments

Holistic Approach Skills Teaching

Support in

implementation for

staff and family

Differential

Reinforcement of

Alternative

behaviours

Quality of Life

assessment

Systematic Process

Addressing the

environment

Clear guidelines for staff administering the

medication Clear unambiguous language (operationally defined)

• When engaging in head banging for 5 minutes and staff have been unsuccessful in redirecting using technique 1,2,3.

• Head banging is defined as “Tom moving his head forward and hitting it on a hard surface such as a table, the wall, or the floor and producing an audible sound from the contact ” Head banging is not “Tom swaying his head without any contact being made to another object or Tom picking skin from his head”

• If engaging in head banging to the point of drawing blood

Ambiguous language

• Stressed

• Anxious

• Upset

• Threatening

• Self-injurious behaviour*

Dimensions ‘campaign’

• Premise: Every person we support being prescribed

psychotropic medications is at potential risk of being

over medicated or wrongly prescribed.

• Aim: To ensure that every person we support being

prescribed psychotropic medications has those

prescriptions issued and reviewed in line with NICE

guidelines

Key (NICE) Best Practice Guidelines

multi-disciplinary review after 3 months

(context)

multi-disciplinary review every 6

months

meaningful involvement

a reduction or stoppage plan in place

North Survey Results

• 75 people currently prescribed psychotropics (38%)

– including anticonvulsants

• 10 people prescribed psychotropics within last 3 months

– 5 of those had MD review (50%)

• 73 people taking psychotropics for 6 months or more

– 39 of those had 6 monthly reviews (53%)

– 18 people had no review in the last 12 months (25%)

• 33 people were ‘actively involved’ in prescription or review (44%)

• 40 people had family or advocate involved in prescription or review (53%)

• 11 people have a ‘reduction plan’ in place (15%)

Northern Pilot Actions

o Steering Group

o Engaging with LM’s

Individual action plans – using the toolkit:

Checklist against Guidelines – actions

Meds review prep tool

Reduction Plan Template

Monitored by the Steering Group – accountability

o Monitoring reductions in medications over time

One database

Discussion point 1

For the behaviour support plan (BSP) to incorporate the use of medication

(especially PRN), what do the stakeholders need to do?

• What information is needed? How are we collecting this?

• Are we approaching this as a holistic approach rather than having clinical,

medical and support providers working separately?

• What is in place for support staff to follow?

• How do we make sure that we are all

Within our competencies?

Discussion point 2

• How are we measuring success of an intervention?

• At what point do we look at having a reduction plan in

place?

• How do we will decide what this will look like?

• How are we ensuring that the information is objective

Discussion point 3

• The appropriate use of medication

• Case study example of appropriate and inappropriate use.

• Aim here is to highlight the psychotropic should be seen as a tool that

can be very effective and suitable.

• What markers are we using as “good practice”? if there was a review

process of “appropriateness” what would that include?

• What are the common barriers?

• What are clear indicators that it is not appropriate

• Discuss the STOMP review (how many people had heard of it, how

many had used it?)

Case study: Inappropriate use of medication

• Lady with learning disability and acquired brain injury

• Would wake at night

• Inconstancy of approach from staff

• Would have side effects (next morning)

• Intervention: rewritten the PRN protocol into tick box form for staff,

sign off from the prescribing doctor, competency check staff.

• Results: Reduction in PRN use as well as an Increase in morning

activities

Appropriate medication use

• “Grace” moved from a “poor service” following a 28 day notice period

• During assessment period in her new home she would escalate quickly

(3 minutes) from apparent baseline to crisis

• Engaged in biting herself, kicking staff, screaming, punching walls and

property destruction (this put her placement in jeopardy and resulted in

injuries to her self and staff)

• Her GP prescribed lorazepam following her move and PRN lorazepam

• From warning signs increased before crisis

• Crisis reduced from 6 hours to 20 minutes

• (STOMPwLD) 2016

Discussion point 4

• How are we addressing medication withdrawal effects when

reducing psychotropic medication?

• Is this accounted for within the prescribing patterns and data

collection of challenging behaviour?

• How Commonly is this considered?

• How can we counter this?

• Is this an issue that needs to be addressed?

• Would we ever say categorically that we are never going to

introduce a reduction plan?

Closing Round & Thank You