Medication safety in mental health

National Standard

The National Safety and Quality Health Service Standard 4.2.1 requires that hospitals regularly assess their medication management systems.

The National Standards in Mental Health Services require mental health services to minimise the occurrence of adverse medication events within all mental health settings.

The following medication safety systems support best evidence based practice in reducing adverse medicines events:

• Standardised inpatient medication charts

Standard charts designed using best evidence-based practice, to reduce patient harm at the point of care.

• Medication management plan

This plan is for multidisciplinary clinicians to reconcile medications during transfer of care between settings, to optimise treatment, care and support

• Adverse drug reactions

Documenting adverse drug reaction on the standard medication chart can reduce the risk of patients receiving a medicine that they are allergic to.

• Medication reconciliation

This process produces a complete and accurate medication regimen during transitions of care. Discrepancies are addressed with the prescriber and documented.

Australian Commission on Safety and Quality in Health Care: medication reconciliation

Agency for Health Care Research and Quality: Match Toolkit

Clinical Excellence Commission: medication reconciliation

• High risk medicines

These are medicines with a narrow safety margin. Antipsychotics are included in high-risk medicines lists in some Australian health services.

• Tall Man lettering

This practice reduces the risk of sound-alike, look-alike errors.

• Recommended terminology and abbreviations

This reduces the risk of errors associated with specific terms and abbreviations.

• Partnering with consumers and carers

Persons receiving mental health and wellbeing services are to be supported to make and be involved in decisions about their treatment:

• Mental Health and Wellbeing Act 2022
• Royal Commission into Victoria’s Mental Health System 2021
• Chief Psychiatrist Guideline: Working together with families and carers
• National Standards in Mental Health Services 2010 (10.5)
• Australian Quality and Safety Health Service Standards (2.3-2.7)

National QUM indicators for acute mental health care

See the National QUM indicators for acute mental health care (set 7), (NSWTAG) website for the following indicators:

• 7.1 Percentage of as required (PRN) psychotropic medication orders with documented indication, dose (or dose range), frequency and maximum daily dose specified
• 7.2 Percentage of patients taking lithium who receive appropriate monitoring during their inpatient episode
• 7.3 Percentage of patients who receive written and verbal information on regular psychotropic medicines initiated during their admission
• 7.4 Percentage of patients taking antipsychotic medicines who receive appropriate monitoring for the development of metabolic side effects
• 7.5 Percentage of patients prescribed two or more regular antipsychotic medicines at hospital discharge

National indicators for Quality Use of Medicines (QUM) in Australian Hospitals

National indicators for Quality Use of Medicines (QUM) in Australian Hospitals (full manual)

Examples of National Quality Use of Medicines Indicators, adapted for Mental Health Services)

• 3.1 Percentage of patients whose current psychotropic medicines are documented at admission with information in the clinical record regarding the prescription source, prescription duration, effectiveness and adverse effects
• 3.2 Percentage of patients whose known adverse drug reactions to antipsychotics are documented on the current medication chart
• 3.5 Percentage of medication orders for depot antipsychotics that are prescribed safely
• 5.3 Percentage of discharge summaries that document changes to antipsychotic therapy and include explanations for the changes
• 5.5 Percentage of patients with a new adverse drug reaction (ADR) to antipsychotics that are given written ADR information at discharge AND a copy is communicated to the primary care clinician
• 5.7 Percentage of patients receiving sedatives (for example, benzodiazepines) at discharge that were not taking them at admission
• 5.8 Percentage of patients whose discharge summaries contain current accurate and comprehensive list of medicines
• 5.9 Percentage of patients who receive a current, accurate and comprehensive medication list at the time of hospital discharge