Overmedicating People With Learning Disabilities (STOMP)

STOMP is a recent campaign, backed by the RCN, to stop the overmedication of people with learning disabilities with psychotropic drugs. For this informative video, Student Nurse Laura explains the impacts of overmedication, the importance of STOMP and how to integrate it into your practice.

Hi guys, my name's Laura, and for those of you who don't already know me, I'm an adult nursing student, but I also work as a support worker for people with learning disabilities alongside my studies. And today's video is another video regarding learning disabilities. And today we're going to explore STOMP.

What Is STOMP?

STOMP is a movement that was brought about, and it stands for ‘Stopping the Overmedication of People’ with learning disabilities, autism, or both, mainly targeting, stopping the overuse of psychotropic drugs to control behaviours that can be seen as challenging. STOMP is about helping people to stay well and have a good quality of life without over medicating them.

STOMP was a national campaign launched in 2016 to stop abusing psychotropic medication to manage behaviour and it was a campaign that the RCM backed. STOMP was developed because evidence showed that many people with learning disabilities, autism, or both, were commonly wrongly prescribed psychotropic medications to be used as a chemical restraint on behaviour.

So, these behaviours can be shouting, being noisy, hitting people, having an outburst of emotions that we can't control. So rather than focus on controlling the cause of these behaviours, people were using drugs to chemically stop these behaviours from happening.

What Is The Impact Of Overmedication?

So psychotropic drugs that are designed to treat mental illnesses were being used to treat challenging behaviours in patients with learning disabilities who had no mental illness, so they were wrongly prescribed. And unfortunately, these medications can have a wide range of side effects such as weight gain, drowsiness, changes in mood, distortion of perception, constipation, and anxiety.

As such, the side effects of these medications, especially when they've been wrongly used for patients with learning disabilities, can negatively impact these patients' quality of life as it can affect their mental and physical wellbeing.

Certain side effects can then bring across further illnesses such as weight gain, which can bring across other morbidities. So, then it has a longer, long-term impact on the health, which again will negatively impact their quality of life.

So, it is very important for us as nurses, and obviously for people who work as support workers or as carers for people with learning disabilities, to support our patients or our residents or people that we support, depending what terminology you want to use. And for those of them who are lacking capacity to act in their best interest to try and stop the over medication and implement STOMP where possible.

The side effects of these medications, especially when they've been wrongly used for patients with learning disabilities, can negatively impact these patients' quality of life.

How Can We Do This?

So how can we do this? there are many ways that STOMP can be incorporated into our practice, thus allowing us to act in patient's best interests. And this is especially important when some patients with learning disabilities can lack the capacity to understand their medications and why they are taking their medications.

Especially for patients who have a lack of capacity, combined with challenging behaviours or behaviours that can challenge, it is our job to protect their best interests. As nurses, we can encourage the reduction of use of medication by involving patients and the patient's circle of support as much as possible in their care.

So, when we have a patient come in with a learning disability from a home and this person lacks capacity or this person does have capacity but will still need the support of a carer to make decisions, it is really important that we get the background information off that carer. We read their hospital passport, we ask the carer what normal behaviours there are, how we can use a positive behaviour support plan to manage those behaviours.

As nurses using these things are vital to ensure that we're not going to get medication prescribed to control behaviour when a carer or a support worker can tell you how to deflect such behaviours by removing triggers or de-escalation techniques. And that just eliminates the need to use any sort of medication.

And as a nurse, if we think that somebody is on a medication and they don't need to be on that medication, we should encourage a medicine review. Or as a support worker, we should be having regular medication reviews with the person who supports their GP to make sure that all medication they have is relevant and if they are on any antipsychotics or anything like that, that it is for a relevant mental health condition and not as a cause of behaviour control.

Positive Behaviour Support Plans

Next, some people with challenging behaviours will have a positive behaviour support plan, and a positive behaviour support plan highlights what are the normal behaviours that this person might have, what the triggers to these challenging behaviours might be, and methods that can be used to deescalate such behaviours.

By reading this plan and using it, we can reduce the need to use medication to control behaviour. I know in extreme cases medication might be necessary, but that shouldn't be a mental health medication. That should be a different medication. But by using positive support plans, we shouldn't need to be using medication at all because we should have the tools in place to manage the situation appropriately.

Consider Environmental Factors

Sometimes challenging behaviours are a result of the caregiver or the environment because factors that can be changed or cannot be changed. So, as I quite often talk about sensory inputs, unfamiliar environments, a lack of understanding. If a patient's ill and they're confused, they're not going to know what's going on. It's kind of the same as if you have a confused dementia patient, you are not going to give a dementia patient psychotic medication for their delirium if they don't need it.

It's exactly the same concept here. If an ill patient is confused and they've got learning disabilities, it's just not relevant. And by mitigating these factors, by taking into consideration environmental factors, how you are approaching a person.

So, your behaviour, your persona, the environment that they're in, any sensory issues that they might have, are they stimulated enough? Are they bored? Is that why they're exhibiting challenging behaviours because they're bored? Do you need to get some more interaction with them? And when you look at the whole circle of things, again, there shouldn't be a need to medicate somebody.

Everybody should aim to, if they come across a patient with a learning disability, think STOMP.

Monitoring The Use Of Psychotropic Medications

So also, we can monitor the use of psychotropic medications and if we think that a person we are caring for is being overmedicated, we need to speak up. And that can be talking to a doctor, that can be going to whoever is in charge of your ward or place of work.

And I know if you're in a hospital, go to your learning disability support team, go to your liaison team. They will quite happily take you through the medications, explain the person's behaviour to you and work with you to reduce if you think there is too much medication or work with you, if you are not quite sure how to manage a behaviour. If you contact your learning disability liaison team, they will be quite happy to work with that for you. That is what they are there for. So, utilize them.

Don't go running straight to medication. Use every other thing first. And as always as a nurse, we should be encouraged to advocate for our patients. So, STOMP is another form of advocation for us.

Utilising Teamwork And Education

So, STOMP can quite often require the communication and teamwork of very many different healthcare professionals. So, for example, the patient, the patient's primary caregiver, the nurse, the LD team, the doctor, and the prescriber.

Only through utilizing this whole circle of a team can we find the alternative to medications through non-drug therapies and positive behaviour support plans and environmental changes to find underlying causes of behaviours and get to the root cause of it to try and prevent it from happening.

And I think that this is something that can be quite easy forgotten about when we're quite swept off of our feet. I think it can be quite hard as someone who has no experience of learning disabilities to help somebody with them, and it can be quite hard. And this just comes back down to practice and learning and education.

Moving Forwards

Hopefully we can, even though the STOMP program has finished, we can continue to move forward using these practices because they are good practices. And I think everybody should aim to, if they come across a patient with a learning disability, think STOMP.

And if you think STOMP like you think sepsis, if you keep it in the back of your brain, eventually this will become a thing everywhere. I hope that makes some sort of sense.

So, thank you for watching and if you have any questions about STOMP, type it into Google because there is a lot of information about it. So, thank you very much.