(Title Image: Sunnybrook Hospital)
Health & Social Care Committee
Use of antipsychotic medicines in care homes (pdf)
Published: 17th May 2018
Chair’s Statement, Dr Dai Lloyd AM (Plaid, South Wales West):
“We are disappointed with the apparent lack of commitment to tackling this issue as a priority. We believe cultural and systemic changes are needed to ensure antipsychotic medications are prescribed appropriately, and not as a first option.”
1. Use of antipsychotics should be properly monitored
There have long been concerns over the use of antipsychotic medicines in care homes (and, increasingly, hospital too), usually for dementia patients who have behavioural problems. Antipsychotics can increase the risk of strokes and have been linked to 1,800 deaths across the UK.
There’s absolutely no formal data on their use – a situation the Older People’s Commissioner described as “worrying” – and a number of witnesses called for a national audit. Some health boards have already done this by themselves; Aneurin Bevan health board did so in the Newport area and it’s proven helpful in highlighting patterns of use – something the Committee believes should be rolled-out nationwide.
2. Health boards should stop using antipsychotics on dementia patients unless there’s a serious risk of harm to the patient or others
….this is the NICE (National Institute of Clinical Excellence) guideline, but it’s not being put into practice.
Witnesses raised concerns about antipsychotics being a default treatment for difficult behaviour (aggression, agitation, sleep disturbance) but also for behaviour that doesn’t warrant their use like wandering or being uncooperative.
Care Forum Wales described it as “a national scandal”. Challenging behaviour was often the result of a need (particularly intimate care) that wasn’t being met because a patient is unable to communicate it or doesn’t understand what’s happening.
There was acceptance from dementia bodies like the Alzheimer’s Society that caring for someone with dementia “wasn’t easy” and GPs may be under pressure from care homes themselves or families to use antipsychotics.
3. Medicine use should be routinely investigated during care home inspections
Care Inspectorate Wales is already reviewing how medicine use is investigated and recorded as part of care home inspections. The Alzheimer’s Society wanted this evidence to be included in a patient’s medical records alongside other mandatory records like those relating to nutrition.
There were also calls for all health and social care staff to receive dementia awareness training and taught practical ways of dealing with challenging behaviour (i.e. de-escalation and physical restraint). Some care homes often state that they care for people with dementia, but inspectors often find no staff have had training in dealing with it.
