“Systemic changes” are needed for ensure the appropriate prescribing of antipsychotic medicines in Welsh care homes, according to a report.
It said antipsychotics were being prescribed inappropriately, in many cases as a first option rather than a last resort, to treat the behavioural and psychologic symptoms of dementia.
“We were told that antipsychotics are being used as a default position in care homes and some hospital wards”
They were also often being prescribed without adequate reviews or records being kept, according to the new report from a National Assembly for Wales committee.
The assembly’s Health, Social Care and Sport Committee was told antipsychotics were increasingly being used in care home settings to ‘manage’ challenging behaviour of people with dementia.
As a result, it wants the Welsh government to ensure that all health boards are collecting and publishing standardised data on the use of antipsychotic medication in care homes and report back to it on progress within 12 months.
It also wants to make sure all boards are fully compliant with National Institute for Health and Care Excellent guidelines on dementia.
NICE advises against the use of any antipsychotics for non-cognitive symptoms or challenging behaviour of dementia unless the person is severely distressed or there is an immediate risk of harm to them or others.
“We believe it is vitally important to look at the person as a whole to understand what may be causing a particular behaviour”
In 2009, a report by Professor Sube Banerjee on the use of antipsychotic medication for people with dementia found that antipsychotics appeared to be used too often in dementia and, at their likely level of use, potential benefits are most probably outweighed by their risks overall.
The committee was told that medication reviews were not happening frequently enough for people with dementia, and that treatment often rolled on with repeat prescriptions for long periods without being monitored effectively.
This was particularly concerning as older people are more likely to have complex chronic conditions which require multiple medications, noted the committee.
It has called for every person with dementia presenting challenging behaviour to receive a comprehensive person-centred care assessment of their needs.
Dr Dai Lloyd, chair of the committee, said: “A person living with dementia presenting challenging behaviour often has an unmet need which they may be unable to communicate.
“As such, we believe it is vitally important to look at the person as a whole in order to understand what may be causing a particular behaviour,” he said.
“This can only be achieved when the workforce is properly resourced and staffing numbers are correct”
Dr Lloyd said: “We know that there are various good practice checklists that could be used by staff in care homes to identify the possible causes behind an individual’s behaviour.
“Yet we were told that antipsychotics are being used as a default position in care homes and some hospital wards, when people with dementia are difficult to deal with,” he said.
He added: “We believe cultural and systemic changes are needed to ensure antipsychotic medications are prescribed appropriately, and as a very last resort, not as a default first option.”
Nigel Downes, associate director for professional practice at the Royal College of Nursing in Wales, said the organisation welcomed the report’s findings and recommendations.
Mr Downs, who noted that the college had given evidence to the inquiry last October, highlighted that medicines management in care homes was “often extremely complex and multifaceted”.
“Those with dementia in a care home are likely to require greater levels of care than other patients in similar settings”
He said the committee’s recommendations needed to be “adequately resourced with implementation closely monitored and evaluated to ensure that changes result in real improvements for dementia patients”.
“The RCN agrees that every person with dementia, presenting challenging behaviour, receive a person-centred care assessment,” he said. “The correct treatment should follow based on their individual needs.
“Care homes should also ensure that they are able to offer a range of treatment options for people with dementia, including evidence based psychological therapies where appropriate,” said Mr Downs.
In addition, he stated that nurses had a “key role in providing high quality care”. “Patients with dementia have specific and complex needs, and those with dementia in a care home are likely to require greater levels of care than other patients in similar settings,” he said.
“Therefore, this can only be achieved when the workforce is properly resourced, staffing numbers are correct and staff receiving the correct level of training; especially in relation to dementia-care training,” he added.