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. 2025 Sep 22;18(1):2557873.
doi: 10.1080/20523211.2025.2557873. eCollection 2025.

Exploring quality improvement processes for psychotropic medication use in Australian residential aged care homes: a qualitative study

Shakti Shrestha  1 , Amanda J Cross  2 , Michelle Steeper  3 , Nazanin Falconer  1 , Laurie Buys  4 , Carmela Lagasca  5 , Angelita Martini  6   7   8 , Dayna Cenin  8 , Nancy Ochieng  9 , Francesca Glamorgan  10 , J Simon Bell  2 , Adam La Caze  1
Affiliations

Exploring quality improvement processes for psychotropic medication use in Australian residential aged care homes: a qualitative study

Shakti Shrestha et al. J Pharm Policy Pract. .

Abstract

Background: Recent regulatory changes in Australia have emphasised system-level approaches to ensure appropriate psychotropic medication use in residential aged care homes. This study explored quality improvement processes related to psychotropic medication use in Australian residential aged care homes.

Methods: This qualitative study used in-depth semi-structured interviews with a maximum variation sample of key stakeholders involved in psychotropic medication use at organisations operating facilities in metropolitan and regional areas in four Australian states. The interviews were transcribed verbatim and thematically analysed using both inductive and deductive approaches by two researchers using a framework developed for learning health systems.

Results: Stakeholders (n = 33) included nurses, occupational therapists, pharmacists, medical practitioners, residents and caregivers. Identified themes were (i) regulation was driving change in organisational policies and procedures, and (ii) aged care organisations were enhancing quality improvement systems for psychotropic medications. Many of the requirements of successful healthcare quality improvement systems were present within the aged care organisations, including alignment of core values and presence of key ethical, legal and policy infrastructure. There are opportunities for better use of clinical data to improve care, especially in terms of learning from the data and implementing tailored change. The challenges identified by participants included navigating the perceived tension between compliance and quality, and aligning the goals and processes of all health professionals.

Conclusions: Recent changes in policies, procedures and infrastructure have provided clearer oversight of psychotropic medication use. Individual and system approaches to psychotropic medication use in aged care have shifted. Key opportunities for improving use of psychotropic medications within aged care organisations include improving the capacity to use local data to improve care and building interdisciplinary teams to facilitate collaborative care.

Keywords: Long-term care; dementia; learning health system; psychotropic drugs; quality improvement; residential facilities.

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Conflict of interest statement

JSB has received grant funding or consulting funds from the National Health and Medical Research Council, Medical Research Future Fund, Victorian Government Department of Health and Human Services, Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, Society of Hospital Pharmacists of Australia, GlaxoSmithKline Supported Studies Program, Amgen, and several aged care provider organisations unrelated to this work. All grants and consulting funds were paid to the employing institution. AJC has received grant funding or consulting funds from the Medical Research Future Fund, Dementia Australia Research Foundation and Pharmaceutical Society of Australia. All grants and consulting funds were paid to the employing institution. The other authors declare that there is no conflict of interests.

Figures

Figure 1.
Figure 1.
Summary of key findings. The participating aged care organisations are a developing learning health system.
See this image and copyright information in PMC

References

    1. Aged Care Quality and Safety Commission . (2022). Psychotropic self-assessment tool. Retrieved 28 March, 2024, from https://www.agedcarequality.gov.au/resources/self-assessment-tool-psycho....
    1. Aged Care Quality and Safety Commission . (2024). Restrictive practices provider resources, Aged Care Quality and Safety Commission. Retrieved 28 March, 2024, from https://www.agedcarequality.gov.au/providers/clinical-governance/restric....
    1. Australian Government . (2021). Royal commission into aged care quality and safety. Final Report: Care, Dignity and Respect. Retrieved 25 March, 2024, from https://agedcare.royalcommission.gov.au/publications/final-report.
    1. Australian Government . (2022a). Restrictive practice use in residential aged care. Retrieved 08 July, 2024, from https://www.health.gov.au/sites/default/files/2022-11/types-of-restricti....
    1. Australian Government . (2022b). User guide: role of a medication advisory committee. Department of Health and Aged Care. Retrieved 28 March, 2024, from https://www.health.gov.au/sites/default/files/2022-11/user-guide-role-of....