Medication management within Mental Health Alcohol and Other Drugs (MHAOD) Services

Guideline number: QH-GDL-965:2021

Effective date: 8 October 2021

Review date: 8 October 2024

Supersedes: Version 1

On this page:

  1. Purpose
  2. Scope
  3. Background
  4. Related documents
  5. Clinical governance for medication safety
  6. Supporting consumers and carers with medication related issues
  7. Prescription and administration of psychotropic medications
  8. Pharmacotherapy in specific population groups and situations
  9. Physical health screening, assessment, and intervention
  10. Definitions of terms used in the policy and supporting documents
  11. Additional resources
  12. Approval and implementation
  13. Version control

1. Purpose

To provide a central point for guidance to clinical staff on the use of psychotropic medication, within public mental health alcohol and other drug (MHAOD) services in Queensland.

2. Scope

This Guideline provides information for Queensland Health employees (permanent, temporary and casual) and organisations and individuals acting as its agents (including Visiting Medical Officers and other partners, contractors, consultants and volunteers) working within MHAOD services.

Consistent with the National Safety and Quality Health Service Standards (NSQHS), up-to-date and evidence-based medicine-related information and decision-support tools should be maintained to assist clinicians with their responsibilities to provide a safe and effective medication management. However, rather than developing clinical practice guidelines for the management of individual substance use and other mental health disorders, this document summarises key areas for consideration with related references and links.

The MHAOD Models of Service recognise that care is much broader than medication treatment and should also include psychological, social, lifestyle, cultural and spiritual elements. These elements play an essential role in recovery-oriented practice.

3. Background

The NSQHS Standards provide a nationally consistent statement of the level of care consumers can expect from health service organisations.

The Australian Commission on Safety and Quality in Health Care provides key resources to support the implementation of the NSQHS Standards and medication safety in MHAOD services.

The challenges of meeting these standards in public MHAOD services are complex and require Hospital and Health Services (HHSs) to provide governance over relevant local procedures.

The purpose of the Queensland Psychotropic Medication Advisory Committee (QPMAC) is to provide advice and recommendations on the quality use of medicines (QUM) and psychotropic medication events, to guide medication-related service development and quality improvement activities in MHAOD services.

Queensland Health policies, standards, procedures, guidelines and protocols are available by searching the Queensland Health website.

4.1 Authorising policy and standard/s

  • Mental Health Act 2016 (Queensland)
  • Human Rights Act 2019 (Queensland)
  • Chief Psychiatrist Policy, Clinical need for medication (2020)
  • Chief Psychiatrist Policy, Notification to Chief Psychiatrist of Critical Incidents and Non-Compliance with the Mental Health Act 2016 (2020)
  • Medicines and Poisons Act 2019
  • Medicines and Poisons (Medicines) Regulation 2021
  • Departmental Standard – Monitored Medicines
  • National Safety and Quality Health Service Standards 2017

The Queensland public sector must consider the impact on the human rights of individuals when making decisions and ensure that any decision is compatible with the Human Rights Act 2019 (Queensland). This guideline must be implemented in a way that is consistent with the rights outlined in the Act. Queensland Health staff have obligations under the Human Rights Act 2019 (Queensland) to make decisions and act in ways that are compatible with human rights.

4.2 Procedures, guidelines and protocols

4.3 Forms and templates

5. Clinical governance for medication safety

  • The guideline should be used in conjunction with local HHS medication safety/drug and therapeutics governance mechanisms to promote the safe and quality use of medicines.
  • All prescribers must comply with legislative obligations outlined in relevant legislation. Prescribers should note that some psychotropic medications might have differing regulatory requirements. Prescribers are responsible to ensure their practice meets regulatory obligations.
  • Care planning and care review processes provide opportunities for consideration of medication-related concerns.
  • MHAOD Services should have documented review mechanisms for more complex medication-related issues. Such review mechanisms should include expert advice from outside the treating team, for example another medical specialist or clinical pharmacist.
  • In addition, the Council of Australian Therapeutic Advisory Group (CATAG) provides a framework to support the quality use of off-label medicines in Australian public hospitals entitled: Rethinking medicines decision-making in Australian Hospitals. This document includes seven guiding principles to assist decision-making by health professionals, consumers and committees in the evaluation, approval and use of off-label medicines.
  • The Queensland Health Medicines Formulary, List of Approved Medicines (LAM) is the official statewide formulary for medicines approved for use in all Queensland Health hospitals and services. Prescribing must be in accordance with the LAM and deviations from this will require approval. Approvals for medicines not on the LAM are requested through the Individual Patient Approval Process to a local HHS committee or process. Find more information about medicines approvals and authorities.
  • Queensland Health’s Healthcare Approvals and Regulation Unit have produced fact sheets and supporting documents on the requirements for prescribing and dispensing regulated restricted drugs under the medicines, poisons and pest management regulatory framework. These resources can be accessed via the Medicines and Poisons Act 2019 Fact sheets and supporting documents (Queensland Health website).

6. Supporting consumers and carers with medication related issues

Several available resources emphasise choice, information-sharing and consumer and carer participation in the process of psychotropic medication prescribing.

QPMAC recommends:

7. Prescription and administration of psychotropic medications

A range of resources are available to guide prescribers including:

7.1 PowerPlans

In some HHSs, Statewide PowerPlans (SWPP) exist within the integrated electronic medical record (ieMR) and function to streamline the ordering for clinicians. PowerPlans contain clinical notes and links to clinical guidelines, evidence and research protocols, making it possible to deliver a standardised approach to patient care (although medical officers should use their clinical judgment and not use a PowerPlan for making clinical decisions). For further information, refer to local HHS policy and procedures.

8. Pharmacotherapy in specific population groups and situations

Additional information specific to individual patient groups is also available within dedicated resources freely available online. When using references published outside Australia, be aware that drug doses, licensed indications, and arrangements for government subsidy may vary between countries. Always check the Australian Medicines Handbook and the PBS listings to confirm Australian arrangements.

Pharmacists with specialist MHAOD knowledge and experience are also a significant source of information and advice.

The following examples are not considered an exhaustive list:

8.1 Acute Behavioural Disturbance Management (ABDM)

Care is required around medication use in behavioural emergencies. The following resources are available by searching the Policies and Standards section of the Queensland Health website.

  • Pharmacological management of acute behavioural disturbance management (ABDM) in Queensland Mental Health Alcohol and Other Drugs (MHAOD) Services (adults and older adults) (2021)
  • Guideline for acute behavioural disturbance management (including acute sedation) in Queensland Health Authorised Mental Health Services (children and adolescents) (currently under review)
  • Management of patients with Acute Severe Behavioural Disturbance in Emergency Departments (2016)

9. Physical health screening, assessment, and intervention

There has been increasing awareness and priority placed on detecting physical risk factors and side-effects associated with psychotropic medications. Identified risks should be appropriately considered in treatment planning, including delivering interventions within scope of practice (for example, health literacy or behaviour change counselling) and referral to external services, both of which are physical health interventions for Provision of Service recording.

All clinicians working with consumers are responsible for monitoring, documenting, and managing side effects associated with the use of psychotropic medications, which should be done in collaboration with consumers and their family and carers wherever possible. A nurse or medical officer should be consulted for assessments that may be out of scope for some clinicians in the multidisciplinary team. All staff should proactively pursue opportunities for their own continuing education sufficient to at least maintain their medication literacy.

10. Definitions of terms used in the policy and supporting documents

Term Definition / explanation / details
Psychotropic medicines Medications which are used for the treatment of MHAOD disorders.

11. Additional resources

12. Approval and implementation

Consultation

  • Queensland Psychotropic Medication Advisory Committee (QPMAC)
  • Queensland Health Mental Health Alcohol and Drugs Service Senior Leaders Group
  • Queensland Health Mental Health Alcohol and Drugs Service Clinical Network
  • Monitored Medicines Unit, Chief Medical Officer and Healthcare Regulation Branch, Prevention Division, Department of Health.

Policy custodian: Director, Clinical Governance Unit, Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Department of Health

Approving officer: Chief Psychiatrist, Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Department of Health.

Approval date: 8 October 2021

Effective from: October 2021

Review date: 8 October 2024

13. Version control

VersionDate Prepared by Comments / reason for update
1 08/10/2021 Clinical Governance Team First publication
2 21/12/2021 Clinical Governance Team Clerical amendment

Last updated: 8 October 2021