Medicines Optimisation in East Berkshire Care Homes

The aim of this project is to reduce the overall prescribing of antipsychotic medication for people living with dementia in care homes across Windsor, Ascot and Maidenhead.

In Scotland, NHS Tayside, set out to reduce harm from prolonged prescribing of antipsychotics, reduce the number of prescriptions for antipsychotics, reduce variation in prescribing, to reduce admissions to secondary care and to increase adherence to treatment guidelines. They tested an approach to this by reviewing the need of patients in one care home to continue taking antipsychotics or continue on the same dose . The aim was to review 80{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} of care home patients, educate care home staff in alternative strategies and support GPs.

This project adopts and adapts the Tayside approach to one Berkshire East CCG (Windsor Ascot and Maidenhead CCG) and with planned roll out to the whole of Berkshire East Care Homes. It is expected that up to 60{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} of those people with dementia taking antipsychotics will have their antipsychotic stopped or dose lowered. To better manage the psychological aspects of dementia staff will be trained in techniques that provide alternatives to anti-psychotics


  • Review 80{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} of Care Home patients.
  • Promote safer prescribing of medication for dementia patients – reduce inappropriate prescribing and lower average dosages
  • Raising awareness of alternatives methods  to manage behavioural and psychological symptoms in dementia
  • Promoting dignity in care and a patient centred approach through medication review
  • BCA have input into the training programme and arrangements for nurses and carers in care homes
  • The training programme includes dementia practice, not just medicine management, and is delivered at no cost to the organisation or it’s staff
  • To produce, promote and make readily available to care home staff medication information and best practice guidance in dementia care.

 Anticipated outcomes

  • Improved experience and quality of life for dementia patients in care homes
  • Improved early diagnosis and support for dementia patients including better access to anti-dementia drugs in line with NICE guidance.
  • Carers equipped to use non-pharmacological interventions in place of antipsychotics.
  • Safer prescribing for dementia patients by reducing inappropriate anti­ psychotics prescribing and promoting non-pharmacological interventions to care staff to manage behavioural and psychological symptoms in dementia (BPSD) first line.
  • Better quality healthcare outcomes for dementia patients through better use of medicines, medicines optimisation, stroke risk reduction, reduction in avoidable medicines related hospital admissions and better management of behavioural and psychological symptoms in dementia (BPSD) by promoting non­ pharmacological interventions to care staff as first line.
  • Fewer medication related complications in dementia patients by providing prescribing support and guidance to prescribers and to raise awareness of any treatable causes of  the BPSD (e.g. delirium, pain, depression) through better history taking. Any treatable causes should be treated with the correct specific treatment (e.g. antibiotics for infection or antidepressants for depression).
  • Patients in need of further intervention or support to be referred to the relevant persons/health professionals or  support team for non-pharmacological interventions for patients in care homes in place of  anti-psychotic prescribing.
  • Enhanced dignity in care by promoting awareness of Advance Care Planning (ACP) or ‘Escalation plans’ to include medication issues if relevant.
  • To promote interventions that may avoid unnecessary hospital admissions e.g. falls prevention screening.
  • Raised dementia awareness amongst carers and empowering them with information so that they are better placed to know when and where to seek advice.

Progress update

Review results at October 2013 include:

  • 506 care homes patients reviewed to date (majority have dementia)
  • 61 people attended the multidisciplinary ‘Alternatives to Antipsychotics’ training event
  • Less variation in antipsychotics prescribing (increase in Risperidone first line)
  • Example of ‘Joint working at its best’
  • Local councils now ready to commission ‘Alternatives to antipsychotics’ training for all care staff
  • Antipsychotic prescribing reducing slowly


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