1. Learning from 1000 Lives+ Reducing inappropriate use of anti-psychotics in dementia care within care homes
Elizabeth Bond, MH Lead pharmacist
BCUHB (central)
Medicines Management Program support
16/06/2018 1

2. National Reports UK MHRA 2005 NICE SCIE CG42 Dementia 2007
Banerjee Report 2009
Independent report for the DoH
Well balanced review of risks of antipsychotic prescribing in confused, older patients
Examined the problem and made key recommendations to improve care and reduce hazard of these drugs

3. Review of the evidence
In perspective: For every 1000 people with dementia treated with antipsychotics for 6 – 12 weeks:
improvement in psychosis/aggression
18 CVAE (50% severe)
10 die within 6 – 12 weeks
58-94 gait disturbance
Ref:
Suggested appropriate use, prescribing could be reduced by up to 70%.

4. Recommendations Appropriate antipsychotic use:
Clear indication – other methods tried & failed
Severe symptoms - patient at risk to themselves/others
Risk assessment documented
Dosing: Start low, Go slow, Short term 3 months
Review regularly - consider alternative to drugs at any stage
Reduce and stop if symptoms remit.

5. National Action Dementia Vision for Wales 2011
1000+ lives Collaborative
Dementia Target 3/Medicines management
Reduce inappropriate antipsychotic prescribing for dementia patients
Initially focuses on care home residents
To be extended to all healthcare settings.

6. Improving Dementia Care:
Follow best practice
Document interventions/reviews
Education for all Healthcare professionals
Alternatives to antipsychotic use
Improve communication / sharing of good quality information

7. Conwy Pilot Baseline Audit

8. Conwy Pilot 2011 1. Training for Care Home staff 2. ACHAMPIONS Tool
Introduction to dementia
Communication
Person centred care
Dignity and challenging behaviour
2. ACHAMPIONS Tool
3. Medicines Management Toolkit
4. Communication form - secondary care

9. Medicines Management Toolkit – good practice guideline

10. Common Issues Collaborative learning highlighted the need for:
Multidisciplinary approach
Defined responsibilities
Improved communication across HC settings
Care homes involvement
Improved (access to) training in dementia care
Provision of non–drug treatments/holistic & person centred care approach