Living well in Buckinghamshire care homes through better prescribing

The aim of this project is to ensure that medication prescribed for patients with dementia living in care homes in Buckinghamshire meets their individual needs and enables them to enjoy life and live with dignity.

 Rationale

In a number of areas both locally and nationally pharmacists have been employed to work in care homes to carry out medication reviews. This project adapts and adopts this approach specifically to meet the needs of dementia patients and especially to support a managed reduction in antipsychotic medication prescribing. To facilitate this appropriate alternatives to antipsychotics will be identified and used. This is an area that GPs have found difficult and requested support with.  Added value will come from the pharmacist identifying undiagnosed dementia patients thereby helping to address the low dementia diagnosis rates in Buckinghamshire.

 Objectives

  • To reduce the use of low dose antipsychotics for challenging behaviour in people with dementia in line with NICE-SCIE dementia guidelines (2006)
  • To develop a pathway and suite of treatment options for the management of challenging behavior in people with dementia
  • To improve signposting to alternatives to medication
  • To reduce the incidence of adverse effects of prescribing e.g.  falls or excess sedation
  • To reduce pharmacy spend
  • To identify patients where there is only a presumptive diagnosis of dementia and address this
  • To develop an understanding of alternative to medication in care home staff
  • To ensure patients and carers are involved and informed about prescribed medication
  • To review and develop medicines management processes within care homes to promote and standardized good medicines management practice

The project aims will be delivered by a clinical pharmacist who’s role will to identify and review patients in care homes with dementia focusing on those that are prescribed antipsychotic medication.  This approach has been piloted to good effect and this project will spread that good practice.

Pharmacist Role

The pharmacist will:

  • assess if antipsychotic prescribing is in line with NICE-SCIE guidance.
  • If medication is to be reduced or stopped, the pharmacist will manage and support this process in a controlled manner. They will also advise  on alternatives to medication and support the develop of individualized  care plans for people with dementia and challenging behaviours
  • identify patients being treated for dementia who do not have a formal, recorded diagnosis.  It is anticipated these patients will have a specialist assessment
  • carry out a full medication reviews ensuring patient’s current regimes are optimized and not increasing patient risk or causing avoidable side effects.
  • provide staff training around medicines management: risks and benefits of antipsychotic medication and how to access and utilize  alternatives to pharmaceutical treatment when managing challenging behavior in dementia
  • provide patients and carers with information about any prescribed medication

Any interventions to improve their overall quality of care will be agreed and actioned by the pharmacist in collaboration with care home staff, the G.P. and the carer.

 

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