Reducing psychotropic prescribing in care homes Sue Woodruff Pharmacist – Care Home Co-ordinator, NHS Norfolk

The problem: Trigger: Safeguarding case relating to a care home A wider problem pan-Norfolk? Growing national concerns (BBC Panorama etc.)

The team: Multidisciplinary group Managers from Adult Social Services Specialist Nurses CSCI (now CQC) Pharmacist Inspector Medicines Management Pharmacists Education Pharmacist, UEA Clinical Governance Lead GP/ Clinical Executive Member & Director

What drugs? Antipsychotic medicines Anxiolytics Hypnotics Antidepressants

The issues: Clinical decision to administer a medicine passed to care staff who have no appropriate clinical training Medication used in preference to non- pharmacological intervention Lack of support for care staff GP’s facing pressure to prescribe from care staff

The issues (cont’d) “PRN”medicines administered routinely Lack of written guidance for staff on use of PRN medicines “PRN” medicines administered without documentation to justify their use Side effects outweighing benefits Inappropriate covert administration

NICE guidance Pharmacological interventions should only be used when person is experiencing severe distress or there is an immediate risk of harm to themselves or others Non-drug approaches should be considered ahead of drug treatment

The approach Training module for care staff Guidelines for prescribers Guidelines for homes Self assessment tool

Involving stakeholders Integrated Care conference 2008 – presentation & feedback Trial in Local Authority care home Discussions with prescribers Roll out Identifying concerns & feedback Presented at UKDC October 2008

Progress so far Guidelines sent to homes April 2009 Prescribing guidance sent to practices Jun 2009 Training sessions delivered to approximately 200 care staff Delivery of self assessment tools commenced Summer % delivered to date. Collation of self assessment responses now underway

Next steps Complete delivery of all self assessment tools by May 2010 & collate all responses Action plan – what further support is needed?

What now? “The use of antipsychotic medication for people with dementia – time for action” Sube Bannerjee Nov 2009 (DOH) Reduce prescribing to 1/3 of present level over 3 year period – not just “PRN” use. Will require further support for homes & prescribers

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