Substitute consent for nursing home residents prescribed psychotropic medication.

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

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

METHOD: 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.

RESULTS: 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.

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