Organisational culture must be addressed to reduce psychotropic prescribing in Residential Aged Care Facilities

To the Editor

The study by Westbury et al. (2018) documents the ongoing highly prevalent use of psychotropic medications in Australian Residential Aged Care Facilities (RACFs). Beyond the reported associations with RACF size and location, there are other resident and nursing home factors associated with psychotropic use, which give important insights into why high-level use of psychotropic medicines persists.

Our qualitative study conducted in Australian RACFs, located in Sydney, identified that a major reason for the high-level use of psychotropic medications was the organisational culture (Sawan et al., 2018). Organisational culture profoundly shapes behaviours and decisions as it is the frame by which staff manage perceptions about the work environment (e.g. staff levels, workload, inter-professional conflict) with ideal behaviours. Our research showed that psychotropic medications were used in a way that was inconsistent with ideal standards when the RACF culture was that of staff feeling helpless to do the right thing by the resident and that it was necessary to restrict time on a given task (Sawan et al., 2018).

Westbury recommends effective interventions are required to reduce RACF reliance on psychotropic medications. We would like to highlight that interventions to safeguard residents from inappropriate prescribing, such as pharmacist-led medication reviews and education and training of frontline staff, have been shown to be successful in reducing psychotropic prescribing in RACFs (Nishtala et al., 2009). However, it is the organisational culture which influences how these interventions are actually utilised and consequently their outcomes (Sawan et al., 2018). While measuring the prevalence of psychotropic medication use in RACFs is important for monitoring progress, if ‘more action’ is needed, then it is time to address the contextual influences, such as the organisational culture, to reduce psychotropic prescribing.