Substitute consent for nursing home residents prescribed psychotropic medication

Prescribing psychotropic medications for persons with dementia who lack capacity to give informed consent requires proxy consent under NSW Guardianship legislation.

To survey current practice in complying with legislation and regulations in prescribing psychotropic medications for nursing home residents.

In three Sydney nursing homes, the files of 77 residents identified as having dementia, being on a psychotropic medication and not having capacity to give informed consent, were audited.

In only 6.5% of cases were all regulations adhered to; a further 6.5% attempted and partially completed substitute consent requirements. The problem and the nature of the treatment were documented in 70.1% of cases. In 16.9% of files the only documentation of the prescribed medication was in the medication chart. Doses of medications prescribed were within accepted guidelines.

Current regulations and legislation are not being observed. Recommendations are made as to how to make them more practicable.