Anti‑Psychotic Medication Use Toolkit

This toolkit supports consistent recording, oversight and review of antipsychotic medication use across care settings. It helps providers document indication, consent/capacity, risk discussions, review cycles and deprescribing intent to reduce inappropriate or prolonged use and to demonstrate compliance with statutory and regulatory expectations.

Overview

The toolkit enables organisations to:

• Record indication, dose, start date and intended review schedule for antipsychotic prescriptions.
• Document capacity assessments, best‑interests decisions and any covert administration plans.
• Capture risk/benefit discussions with the person and representatives and evidence of non‑pharmacological alternatives considered.
• Track mandatory review intervals (eg. ≤6‑weekly for dementia where required) and actions to reduce/stop where appropriate.
• Provide auditable evidence for regulators, commissioners and system STOMP/STAMP reporting.

Legislative Requirements

• Care Act 2014 — duty to prevent avoidable harm and ensure safe, person‑centred care; medicines must not be used to inappropriately control people.
• Mental Capacity Act 2005 — antipsychotics must not be given covertly or against wishes where capacity exists. Where capacity is lacking, use a documented best‑interests process, record least‑restrictive options and review at defined intervals; consider DoLS if deprivation of liberty arises.
• Human Medicines Regulations 2012 — prescribing, supply and administration must comply with medicines law.
• Data Protection Act 2018 / UK GDPR — medication records are special category health data; process under appropriate lawful bases and safeguards (data minimisation, security, access controls).

Regulatory Guidance

CQC (England)

• Antipsychotics should only be used for clear clinical indications (risk of harm to self/others or severe distress), at the lowest effective dose for the shortest time, after non‑drug options have been considered.
• For people with dementia on antipsychotics, providers must show: documented indication, dose/duration, recorded risk discussion, and reviews at intervals of six weeks or less, with deprescribing plans where appropriate.
• Covert administration requires MCA assessment, best‑interests documentation and robust local governance.

Care Inspectorate (Scotland)

• Expectations focus on preventing inappropriate control by medicines, documenting capacity and following MWC good practice for covert administration and distressed behaviour management.
• Evidence of multidisciplinary review, pharmacist involvement and regular review must be available.

CIW (Wales)

• Providers must demonstrate safe medicines management: clear policies, staff competence, accurate records and audit trails for antipsychotic use and reviews.

Statutory Guidance and Accountability

• Accountability — timely reviews by the appropriate multidisciplinary team and clear record of decision makers and rationale.
• Duty of Candour — openness with individuals and families about rationale, risks and outcomes.
• Safeguarding — systems to prevent medicines being used as inappropriate control; trigger safeguarding pathways where misuse or harm is suspected.

Health care Guidance

• Follow national medicines optimisation frameworks (including STOMP/STAMP principles) to ensure involvement, MCA compliance and safe prescribing.
• NICE (eg. NG97; QS85) advises lowest effective dose, frequent review (at least 6 weekly in dementia), and covert medication only after best‑interests processes with management plans and reviews.
• Scottish and Welsh health directorates expect documented non‑pharmacological approaches first and pharmacist involvement for decision support.

Evidence and Best Practice

• Recognise known risks of antipsychotics in older adults (eg. stroke, increased mortality, sedation, falls) and use deprescribing where benefits do not outweigh harms.
• Document risk/benefit discussions and attempts at non‑pharmacological interventions prior to prescribing.
• Local/system targets and STOMP action plans support year‑on‑year reductions and audits of prescribing prevalence and review completion.

Clinical Governance and PSIRF

• Record antipsychotic‑related risks on risk registers and incident systems to inform training, competency and quality improvement.
• Treat harms linked to antipsychotics (eg. over‑sedation, aspiration, medication errors) as patient safety incidents under PSIRF with a systems‑based response and learning actions.
• Include pharmacy, prescribers, nursing and, where relevant, mental health specialists in governance reviews.

Toolkit Statistics

• National prescribing trends show sustained increases in antipsychotic prescribing historically; NHSBSA (2024/25) reported approximately 13.9 million antipsychotic items prescribed to ~873,000 patients in England.
• Historical dementia prescribing prevalence data and audits (eg. National Dementia and Antipsychotic Prescribing Audit) inform local reduction efforts and STOMP reporting.

Using the Toolkit — Practical Steps

1. Create an Antipsychotic Medication Event — record person, prescriber, medication, indication, dose, route, start date and planned review date.
2. Document Decision Making — capture capacity assessment (decision‑specific), best‑interests reasoning if capacity lacking, and any DoLS considerations.
3. Record Risk Discussions — evidence that person/representatives were involved; record alternative non‑pharmacological interventions tried and outcomes.
4. Flag Covert Administration — where relevant, attach covert medicines plan, MCA paperwork and multisource approvals; restrict access to sensitive documents.
5. Schedule and Track Reviews — set mandatory review reminders (eg. ≤6 weeks for dementia) and record outcomes: continue/adjust/deprescribe with rationale.
6. Escalate Safety Concerns — log incidents or adverse effects, notify pharmacy/medical lead, apply PSIRF where harm occurs and follow safeguarding pathways if misuse suspected.
7. Audit and Report — extract reports for STOMP/STAMP metrics, local reduction targets, and regulator evidence (indication, reviews and deprescribing plans).

Templates & Data Fields (recommended)

• Person details, location and responsible clinician
• Medication name, formulation, dose, route, frequency and start date
• Indication / clinical justification (specific)
• Decision‑specific capacity assessment (date, assessor, outcome, supports used)
• Best‑interests record (participants, decisions, rationale) and DoLS status where relevant
• Covert administration plan and approvals (if applicable)
• Risk/benefit discussion notes and alternatives attempted
• Planned review date and mandatory review interval field
• Review outcome (continue / adjust / reduce / stop) with prescriber signature
• Incident/adverse event linkage and audit trail

Monitoring, Audit and Reporting

• Maintain a register of all people currently prescribed antipsychotics with indication and next review date.
• Audit completeness of capacity/best‑interests documentation, covert plans and review timeliness.
• Report STOMP/STAMP metrics and local reduction progress to governance committees and ICS/board as required.
• Use incident and PSIRF outputs to inform training, policy updates and system improvements.

Training & Competence

• Ensure staff training in: medicines management, MCA and capacity assessment, covert administration procedures, risk assessment and non‑pharmacological alternatives.
• Provide competency checks for staff involved in administration and record access controls for sensitive documentation.
• Include prescribers and pharmacists in multidisciplinary education on deprescribing and STOMP/STAMP principles.

Value Proposition

• Helps organisations meet statutory, regulatory and best practice expectations for antipsychotic use.
• Provides auditable records of capacity, best‑interests decisions, risk discussions and review cycles.
• Supports deprescribing initiatives and STOMP/STAMP compliance and local performance reporting.
• Reduces risk by ensuring timely reviews, incident linkage and governance oversight.

References

• Care Act 2014
• Mental Capacity Act 2005
• Human Medicines Regulations 2012
• Health & Social Care Act 2008 (Regulated Activities) Regulations 2014
• NICE guidance (NG97, QS85)
• STOMP / STAMP national programmes and NHS England resources
• MHRA guidance and NHSBSA prescribing data (2024/25)
• Scottish intercollegiate guidelines and Mental Welfare Commission good practice
• CI Health and Social Care Standards; CIW National Minimum Standards
• NHS Patient Safety Incident Response Framework (PSIRF)
• UK GDPR and Data Protection Act 2018

Disclaimer

Radar Healthcare provides configuration templates and implementation guidance to support effective use of the platform. Any data protection or regulatory examples are for general guidance only and do not constitute legal, clinical or compliance advice. Radar Healthcare acts as a data processor under customer instruction. The customer, as data controller, remains responsible for assessing and managing legal and data protection risks, determining lawful processing, ensuring clinical governance and compliance with applicable regulations.