Within Hertfordshire we work closely with the NHS Clinical Commissioning Group (NHS CCG) pharmacists to improve medication reviews and reduction.
In Hertfordshire we were historically lower than average users of antipsychotic medication for Behavioural and Psychiatric Symptoms of Dementia (BPSD) compared to national position.
As part of the Complex Care Premium (CCP) training, champions are trained in;
- safe and appropriate use of antipsychotic medication using NICE guidelines
- symptoms of BPSD
- adverse effects and risk factors
- non pharmacological interventions
Through partnership and multidiciplinary team working there has been a significant reduction in the use of antipsychotic medication
Effective medication management reduce falls and risks or cardiovascular events
Mrs JC is a resident in a North Hertfordshire care home, living with advanced dementia. Two years ago, the local community mental health team had been asked to be involved as her behaviour was becoming challenging, she was spitting at staff and other residents. Following their review it was decided that a low dose of an antipsychotic medication (risperidone) should be prescribed to help manage this.
Antipsychotic medication can increase the risk of cardiovascular events including stroke and NICE guidance states that they should only be used if the patient is at risk of harm to themselves or others. When they are used they should be used at the lowest possible dose and for the shortest possible time. They can also increase of falls and have other side effects such as blurred vision , constipation and movement disorders.
Two years later the CCG care home pharmacist ,employed as part of the NHSE Vanguard programme, was reviewing medication for all residents in the care home.
Behavioural symptoms of dementia can sometimes subside on their own as they are often due to external factors such as noise/environment or can be as a result of infection or untreated pain.
Review
After discussing Mrs JC’s care with her main Care Practitioner and reviewing her other medication and medical history the residents medication was discussed at a multidisciplinary meeting which included the GP, Care Practitioner and Pharmacist.
Agreed action
The Care practitioner confirmed that behaviour appears to have settled and that the resident was no longer spitting at other residents or staff so it was agreed to reduce the dose slowly with the aim to stop medication all together. The Care Practitioner was advised to monitor closely and report anything of concern back to the GP.
Outcomes
After four weeks the medication was successfully stopped and the residents behaviour did not worsen. Risk of a cardiovascular event or fall have been reduced.
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