Implementation of National Clinical Guideline No. 21

Non-cognitive symptoms of dementia include symptoms such as delusions, hallucinations, depression, anxiety, and apathy. Up to 90% of people with dementia experience non-cognitive symptoms. People with dementia experiencing these symptoms may be supported using non-pharmacological interventions and/or psychotropic medications.  Non-pharmacological interventions are non-invasive interventions that do not involve medication and attempt to better manage complex needs. Some examples of non-pharmacological interventions include music therapy, physical exercise and cognitive stimulation therapy. Psychotropic medications are medications capable of affecting the mind, emotions and behaviour through an effect on the chemical makeup of the brain and nervous system. There are a number of different categories of psychotropic medications including antipsychotics, antidepressants and hypnotics.

The Irish National Dementia Strategy (Department of Health, 2014) identifies psychotropic prescribing as a key issue.  Non-cognitive symptoms of dementia: Guidance on non-pharmacological interventions for healthcare and social care practitioners was published in 2019 by the National Dementia Office to provide detailed information and guidance on the use of non-pharmacological interventions in managing non-cognitive symptoms in people with dementia. This document can be accessed below.

Furthermore, the National Clinical Guideline (NCG) on “Appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia” (hereafter referred to as NCG No. 21) was published by the Department of Health in December 2019 to guide the appropriate use of psychotropic medication for non-cognitive symptoms in a person with dementia (in any setting). This is complemented by a clinical algorithm for clinical staff and a “patient and family Information leaflet” for a person living with dementia or caring for a person with dementia, or the general public. 

The National Dementia Office secured funding through the Health Service Executive (HSE) National Service Plan to implement NCG No. 21 by an Implementation Programme team. The primary aim of the programme is to implement the guideline on a phased basis across settings, in acute care, residential care, and within community settings. In addition, the project also aims to evaluate the impact of the implementation of the guideline. A national Steering Committee provides governance, guidance and direction in order to attain the overall objectives of the project. An Education Working Group has also been convened to provide input and guidance specifically on the development and rollout of the education and training programme.

The key objectives of the implementation programme are to:

  1. Raise awareness of the risks of psychotropic medications for people with dementia, and to raise awareness of NCG No. 21 as a key resource to guide clinical decision-making, among health care professionals, people with dementia and their families, and other key stakeholders.
  2. Develop a multi-component education programme to encompass facilitator education, an eLearning programme of education, and educational infographics.
  3. Provide education to relevant staff in acute hospitals, mental health settings, residential settings for older people, and community settings on the content of NCG No. 21, using a facilitator model of education.
  4. Develop, pilot and disseminate an audit tool and audit manual to assess compliance among doctors, nurses and pharmacists, and provide education on use of this audit tool as part of the education and training programme.
  5. Undertake a comprehensive evaluation of the implementation of NCG no. 21 to assess the reach of the education and training programme, namely that the guideline is widely disseminated and available for use in clinical areas caring for people with dementia, and that staff have access to the education programme and are released to participate or complete the online education module.

Relevant Resources

 A range of resources have been developed by the Implementation Programme team, which can be accessed below. This includes:

  • A document to support comprehensive assessment
  • A prescriber information leaflet
  • Prescribing Psychotropic Medication for Non-cognitive Symptoms for People with Dementia: A guide for people with dementia and their family carers and supporters (Plain English version)
  • Prescribing Psychotropic Medication for Non-cognitive Symptoms for People with Dementia: A guide for people with dementia and their family carers and supporters (Easy Read version)

Recent Activities

Launch of HSeLand Module: Non-cognitive symptoms of dementia 

The HSE National Dementia Office has launched a new eLearning module to support all healthcare professionals who provide care to people with dementia across all settings. Available now on HSeLanD, the new eLearning module ‘Support pathways for people with non-cognitive symptoms of dementia’ will help to determine the best person-centred supports for a person with non-cognitive symptoms of dementia and to recognise the risks of unnecessarily prescribing psychotropic medication.

The module contains 3 key topics:

  • Non-cognitive symptoms of dementia
  • Tailored person-centred support
  • Risks of psychotropic medication

This module will take approximately 30 minutes to complete and includes an assessment and extend my learning pieces for those who wish to undertake further learning or who want practical activities to help transfer the learning into their local area of work. Please search “non-cognitive symptoms of dementia” on the HSeLanD website to find this module or you can access the module in “clinical skills” section of the course catalogue on HSeLanD.

Webinar on Non-cognitive Symptoms of Dementia

On 21st September 2022, to coincide with World Alzheimer’s Day, the HSE National Dementia Office and National Safeguarding Office jointly hosted a webinar on non-cognitive symptoms of dementia, entitled “A focus on non-cognitive symptoms of dementia: Promoting a culture of safety”.

Irish Gerontological Society Podcast

To mark World Alzheimer’s Day in 2022, Edel McDaid from the Irish Gerontological Society recorded a podcast with Mairéad Bracken-Scally, Kate Brennan and Fiona Foley from the National Dementia Office. This podcast provides an update on recent activities within the National Dementia Office, including the implementation programme. Access the podcast on the Irish Gerontology website.

Meet the Team 

Dr Mairéad Bracken-Scally, Senior Project Manager

Sheena Farrell, Project Facilitator

Rachel Ward, Project Facilitator

Grace Bergin, Assistant Staff Officer