A wide-ranging strategy has been developed, based on guidance from the Department of Health’s Living well with dementia : A National Dementia Strategy, consultation with regional and local experts, plus help and advice from residents with dementia and their carers.
Reducing the Use of Antipsychotic Medications
The problem, nationally (and to a large extent internationally), may be summarised as follows. Antipsychotics are drugs intended primarily for the management of psychosis (including delusions, hallucinations and disordered thinking). While antipsychotic drugs are very commonly used in the care of people experiencing behavioural and psychological symptoms of dementia (BPSD), it is now understood that these drugs only have a beneficial effect in about one-third of dementia patients. People with dementia in hospitals or care homes were up until recently very likely to have been prescribed antipsychotic drugs; more often than not unnecessarily.
Local audits suggest that there is relatively low use of these medicines in Wolverhampton, compared to other Primary Care Trusts in the region. The government has recommended a major reduction in the levels of use of these medicines, because they place people at increased risk of death and other serious complications such as stroke.
What is Wolverhampton proud to have achieved so far?
- A joint working group (comprising the West Midlands advisor regarding prescribing in dementia, and various local representatives) has been established to review the use of these drugs in Wolverhampton.
- A joint action plan has been developed to address the recommendations of the Department of Health’s “Report on the prescribing of anti-psychotic drugs to people with dementia: time for action” (2009) report.
- Audits have been completed to estimate local use of antipsychotics.
- GPs have been provided with updates regarding safe prescribing of antipsychotics.
- Two education sessions have been delivered for GPs.
- Education of care home staff has started concerning the better management of challenging behaviour in care homes.
What are the areas for continuing improvement where Wolverhampton hopes to do better?
- Regular audits concerning the use of antipsychotic medication will be performed, to track progress and help identify areas for further improvement.
- Prescription guidelines will be developed jointly, for use across Wolverhampton.
- Education will be provided across all aspects of health and social care in relation to safe use of antipsychotics, with the emphasis being placed on alternative person-centered approaches and therapies for people showing BPSD (behavioural and psychological symptoms of dementia).
- Dementia Champions will play a key role in encouraging and enabling staff in care homes to use alternative interventions and thereby reduce the inappropriate use of anti-psychotic medications.
- Further opportunities will be explored, throughout health and social care contracts, to improve quality outcomes relating to the use/misuse anti-psychotic medication.
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Persons wishing to submit advice or comments may email either:
Alternatively, telephone your comments to Tracy Cresswell on 01902 445894 or Rose Powell on 01902 555494.
A Joint Dementia Strategy for Wolverhampton: Consultation, 16 May 2011 – 8 August 2011. Wolverhampton: Wolverhampton City Council [and] Wolverhampton City Primary Care Trust, Summer 2011.