Aware that avoid chemical restraints or prevent the inappropriate prescription of psychotropic drugs in older people with dementia is still a pending issue in many residences, the Maria Wolf Foundation has developed the application methodology of the CHROME criteriaa system designed to monitor the application and use of these substances with the help of third parties.
The CHROME criteria (acronym for CHemical Restraints avOidance MEthodology) have been developed to avoid potential side effects of psychotropic drugs among the elderly population dementias of the Alzheimer’s typeamong which are the falls and fractures bones or the infections such as pneumonia and heart attacks, which imply a higher mortality and an unnecessary loss of quality of life.
The application of the CHROME Criteria avoids chemical restraints and the inappropriate prescription of psychoactive drugs
So, the chemical fastening is designated by the CHROME Criteria as a inappropriate administration of psychotropic drugs administered for organizational convenience or without a neuropsychiatric diagnosis. In countries like Spain, there are many residences that require, for organizational reasons, that the elderly remain in bed for at least 12 hours (4 or more hours than adequate), and many of these people do not suffer from insomnia or sleep disturbances that could justify these drugs. Also called chemical bonding administration of sedative drugs to people who demand attention or manifest behaviors that disturb the environment.
As indicated from the Maria Wolf Foundation, it is completely wrong to assume that this problem is caused solely by doctors. there is also the social pressure both the managers of the centers, as well as other professionals who erroneously demand medical solutions to problems that are not medical, but of coexistence or due to an obsolete residential management model: overcrowding, lack of personnel, ignorance of Non-Pharmacological Therapies that can avoid or complement the use of psychotropic drugs, organizational adjustments of the centers, staff training, etc.
Also they residents’ relatives are partly responsible for these practices due to their influence on specialists to obtain more sedative drugs or doses without being aware of the adverse effects or the additional burden of possible side effects in care (falls, incontinence, medical complications, etc. .).
And to this must be added the frequent lack of coordination between specialists who prescribe these drugs and the doctors in the residences who could adjust or withdraw unnecessary or ineffective treatments.
For all these reasons, the Maria Wolff Foundation, together with a panel of prestigious experts, have created the CHROME criteria that make it possible to comprehensively solve the medical, pharmaceutical, organizational and legal challenges for the avoid chemical restraints and promote the prescription of quality psychoactive drugs. Professionals from disciplines such as geriatrics, neurology, psychiatry, psychology, pharmacy, center management and law have participated in its design.
The implementation of the CHROME Criteria is carried out in a simple way: in a first phase, the health personnel and managers of the centers are trained in the CHROME Criteria. Afterwards, all the pharmacological prescriptions of the residents of the center are reviewed and adjusted to said criteria. The process culminates with the verification of compliance with the CHROME Criteria by external physicians recommended by the Spanish Confederation of Associations of Relatives of People with Alzheimer’s and other Dementias (CEAFA).
For Ruben Muñiz, the use of optimal drugs forces healthcare teams to improve care
And it is that residences that are committed to a quality prescription achieve a significant improvement in the lives of residents. Furthermore, as stated by the Dr. Juan Luis Beltran AguirreVice President of the Spanish Society of Public Health and Health Administration, «The legal part of the CHROME Criteria shows that the use of ‘chemical restraints’ has no protection in the Spanish Constitution and in the laws, and that the inappropriate use of psychoactive drugs can carry legal responsibilities«.
In this sense, for Manuel Martin Carrascopsychiatrist and president of the European Council of National Psychiatric Societies of the European Psychiatric Association and coordinator of audits of the CHROME Criteria of , “With the CHROME Criteria, there is no longer an excuse to look the other way when it comes to prescribing psychotropic drugs, since they include all the necessary elements to guarantee a quality prescription thereby avoiding any unnecessary chemical bonding and adverse effects.”.
“The criteria represent an important step for help doctors properly diagnose residents and optimize drug treatment or avoid it”comment Javier Olazaranneurologist and scientific director of the .
For his part, Ruben Munizresearch director and executive coordinator of the project, ensures that “The use of optimal drugs forces healthcare teams to improve care because with psychotropic drugs they can mask other medical, organizational or care problems. In this way, families often see their loved ones as more alert or communicative. Companies truly interested in offering medical-care quality guarantees to their residents have an opportunity in the CHROME Criteria to publicly show their commitment to residents, since CEAFA can audit and certify the quality of prescriptions”.
In addition, the application of this methodology can generate a savings of psychotropic drugs in residences of about 11 million euros per year, without counting the indirect costs due to falls and admissions to the emergency room, which could well multiply, highlights Ana Rigueirapharmacist member of the panel of experts.