National Assembly for Wales calls for ‘systemic changes’ to antipsychotic prescribing in care homes

Care home residents taking dementia medication should receive mandatory three-monthly medication reviews, the National Assembly for Wales’ Health, Social Care and Sport Committee has said. The reviews should be carried out “with a view to reducing or stopping the medication following the first review, where possible”.

The recommendation, which had been called for by the Royal Pharmaceutical Society (RPS) Wales, was made in a report published on 17 May 2018, following an inquiry into the inappropriate use of antipsychotics in care homes. Dai Lloyd, chair of the committee, said that “cultural and systemic changes are needed to ensure antipsychotic medications are prescribed appropriately, and not as a first option”.

Antipsychotics are often prescribed to help manage the psychological and behavioural symptoms of dementia, but expert bodies — including RPS Wales — had previously expressed concern about over-prescribing and inappropriate long-term use of the medicines. NICE guidelines state that patients with dementia experiencing non-cognitive symptoms, or displaying challenging behaviour, should only be given antipsychotic medicines if they are severely distressed or presenting an immediate risk of harm to themselves or others.

In the new report, the committee asks the Welsh government to ensure all health boards are fully compliant with these guidelines within 12 months. The report also said that health boards should, again within a year, collect and publish standardised data on the use of antipsychotic medication in care homes. Within six months, national dementia-care training standards for care home staff should be developed, the committee said.

Several of these interventions were also proposed by RPS Wales in its response to the committee’s inquiry. Elen Jones, interim director for RPS Wales, led the Society’s work on medicines use within care homes. Jones said she was “delighted to see that so many of our calls have been adopted by the committee, including our calls for care home residents to receive regular medication reviews, for medicines monitoring to be a key part of care home inspections and the need for all Wales training standards for care home staff”.

Jones added that she “strongly urges the Welsh government to accept these recommendations”.

Suzanne Scott-Thomas, chair of the Welsh Pharmacy Board, said it was “vital that the conditions are now created for pharmacists to work with other health professionals across the health and social care system to improve antipsychotic use”.

“I hope this report can harness pharmacist independent prescribing expertise and enable pharmacists to consult directly with residents of care homes.”