Optimizing medications
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Page posted: 3/6/24
This page provides guidance to support a person throughout the time they are taking a psychotropic medication or other type of medication.
Collect data and conduct reviews on a regularly scheduled basis
The licensed practitioner should regularly and systematically review all the person’s medications using information gathered by the person and their support team. The licensed practitioner should review for indication, effectiveness, side effects and ongoing need to continue the medication. Data collection and analysis of trends in the data over time provide evidence of the person’s progress and an opportunity to problem-solve when improvements are insufficient.
Through regular reviews, the licensed practitioner should be able to identify whether a psychotropic medication produces the desired effects for the person’s symptom management and improved quality of life. A medication might not be appropriate if it helps the condition it was intended to address but also has negative effects (e.g., prevents the person from reaching their goals, causes discomfort or prevents engagement in preferred activities). In addition to collecting and reviewing data on target symptoms (refer to Psychotropic Medication Manual – Preparing for appointments), the support team should also routinely review other factors that relate to the person’s overall quality of life (refer to Psychotropic Medication Manual – Quality-of-life assessments).
The 245D service provider can use the following table to discuss data about target symptoms and quality of life with the licensed practitioner.
Target symptom | Quality of life | Is the treatment effective? |
Decrease | Worse | No |
Decrease | Stable | Possibly |
Decrease | Better | Yes (optimum outcome) |
Stable | Worse | No |
Stable | Stable | No |
Stable | Better | Possibly |
Increase | Worse | No |
Increase | Stable | No |
Increase | Better | No |
Find the minimal effective dose
The ideal outcome for the person receiving psychotropic medications is that their quality of life improves and the frequency and/or intensity of their targeted symptoms reduces over time. If a medication achieves the desired results, the person and their support team should meet with the licensed practitioner to discuss the future and determine whether the current dosage is the minimal effective dose. Positive outcomes do not necessarily require that the frequency or dose be reduced. In some cases, the person might have better outcomes with continuation of an established dose rather than repeated trials of medication reduction.
Decisions to change a medication should be based on recommendations from the licensed practitioner and the person’s:
If the licensed practitioner recommends reducing or ending the medication and the person and their support team agree with this decision, DHS generally recommends a gradual (rather than immediate) dose reduction to minimize potential withdrawal effects and to monitor for worsening of symptoms. The licensed practitioner should review past attempts at medication reductions before they determine whether to change a medication.
Support people when there are staffing shortages
Sometimes, the 245D service provider might need to determine how to help the person increase their independence and reduce their supports gradually. Other times, the provider might need to plan for future staff changes and develop a plan to share information with new workers to ensure there is no relapse or gap in the person’s care. There are many tools for transitional planning. One tool that might be helpful for new staff is a one-page, person-centered description that captures important information about the person (refer to Helen Sanderson Associates – One-page profiles).
Additional resources
Psychotropic Medication Manual
Psychotropic Medication Manual – Initiating medications
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