A clinical audit to improve the assessment and management of behaviours of concern in people with intellectual disability.

This clinical audit allows you to review your current practices for an assessment and management of patients with an intellectual disability who present with behaviours of concern. It encourages the investigation of physical and mental health disorders, sensory impairments, and changes in life circumstances and environment, before deciding on a management plan.

Clinical audit | Hours = 6 | RACGP QUCPD Category 1 = 40 points | GPs only | QI ALM
This activity is NOT eligible for procedural skills or emergency medical training grants.
Swinburne University of Technology, and the Centre for Developmental Disability Health, Monash Health
Audit Aim
This clinical audit allows GPs to review their current practices when their patients with an intellectual disability present with a change in behaviour. It encourages the investigation of disorders of physical and mental health, sensory impairments, and changes in life circumstances and environment, before deciding on management plan.
Relevance to General Practice

People with an intellectual disability can present with a change in behaviour that may impact on their own safety and that of others. These are termed “behaviours of concern”. Behaviours of concern may be an expression of pain or distress related to physical or mental ill health, the patient’s social or sensory environment or changes in their life circumstances, or a combination of these factors.

Many people with intellectual disability have difficulty describing their symptoms or experience and so an assessment framework is helpful in ensuring all potential contributing factors are identified.

Evidence suggests that GPs often prescribe medication to modify behaviours of concern. This is termed “chemical restraint”. The use of an assessment framework facilitates accurate diagnosis and therefore effective and timely management of the underlying cause or causes of behaviour change. Using medication as a chemical restraint may not address the cause of the behaviour and should only be used as a last resort, for a short term intervention, and at the lowest effective dose.

Learning Objectives
Enhance GP’s systematic assessment of causes of behaviours of concern in patients with an intellectual disability.
Encourage a multidisciplinary approach to the management of behaviours of concern in patients with an intellectual disability, in which the GP works with, and refers to other health professionals to best address the patient’s needs.
Ensure evaluation of the reasons for, and appropriateness of chemical restraint in the management of behaviours of concern in patients with an intellectual disability.
Promote the identification of opportunities for improvement in the GP/practice’s management of patients with an intellectual disability.
Audit Structure

This audit requires you to identify and record data for five patients patients with an intellectual disability, who present with behaviours of concern. These may be patients seen in the last 12 months (data entered retrospectively from your records) or patients you see any time in the 12 months from enrolling in this activity (data enter prospectively at or following consultations).

For the purposes of this audit intellectual disability includes congenital intellectual disability (ID), acquired brain syndrome (ABI), autism spectrum disorder (ASD) or other significant cognitive impairment including Alzheimer’s disease, multifocal or other dementia.

To be credited with RACGP QI&CPD points you must complete the following tasks in sequence:

  1. Pre-Audit Activities (up to 55 minutes)
    Complete an interactive module including required reading and a brief multiple-choice questionnaire.
  2. Patient Audit (approx. 30 minutes per patient)
    For each patient complete the Patient Data Questionnaire which pertains to the patient’s medical context and care, the nature of behaviour(s) of concern, your actions in investigating and addressing these behaviours and your future plans for the patient.
  3. Accessing Resources (approx. 15 minutes per patient)
    Access resources relevant to each patient. Please refer to the resources section, where you can find up-to-date publications and three educational courses focusing on behaviours of concern and physical health, mental health and life circumstances. Note what resources you used for each patient.
  4. Follow-Up Questionnaire (up to 60 minutes)
    Four weeks after entering data for your final patient, complete a questionnaire reflecting on your actions during and following the audit.
  5. Evaluation (approx. 20 minutes)
    Evaluate this activity and provide feedback regarding potential future training in this area.
Domains of General Practice
D1. Communication skills and the patient-doctor relationship
CS 1.1.1 Communication is clear, respectful, empathic and appropriate to the person and their sociocultural context
D2. Applied professional knowledge and skills
CS2.2.9 Rational prescribing and medication monitoring is undertaken
D3. Population health and the context of general practice
CS 3.2.3 Effective leadership improves outcomes for patients
D4. Professional and ethical role
CS4.2.1 Professional knowledge and skills are reviewed and developed
D5. Organisational and legal dimensions
CS5.1.3 Relevant data is clearly documented, securely stored and appropriately shared for quality improvement
Curriculum Contextual Units
DB16 Individuals with disabilities

Content partners: This audit was developed in collaboration with the Centre for Developmental Disability Health (CDDH) and the Victorian Government Department of Health and Human Services (DHHS).

To enrol in this activity click the enrol button, or for more information please contact A/Prof Rachael McDonald at rachaelmcdonald@swin.edu.au.