The aim of this project is to improve the prescribing of pharmacological interventions for the treatment of behavioural and psychological symptoms of dementia (BPSD), with special focus on antipsychotic use in a care home setting.
The elderly care team (ECT) at Birmingham and Solihull ICB observed a reluctance to deprescribe or review medication in relation to a person's dementia. Due to the systems in place, dementia diagnosis and ongoing monitoring is conducted my local mental health trusts. Therefore GP's felt it would be appropriate to allow the trusts to review all the medication prescribed.
As a region, the midlands is one of the higher prescribers of antipsychotics for dementia. The elderly care team at Bsol ICB worked in collaboration with pharmacists at Birmingham and Solihull Mental Health Foundation Trust (BSMFHT) in order to conduct full medication reviews on residents in Care Homes living with dementia. The specific criteria included only patients prescribed medication (antipsychotic or anxyolitics etc.) for BPSD.
Between October 2021 and October 2022 149 patients were reviewed across 20 care homes in Birmingham and Solihull. From those reviews we were able to make 54 interventions specially around BPSD management. These interventions included dose reductions and gradual withdrawal regimes. A total of 9 antipsychotics were discontinued and 19 z-drugs (for management of insomnia) were stopped. The total estimated annual drug cost savings amount to £14,967.81 and there was a potential impact on adverse drug reaction related hospital admissions and mortality rate. As full medication reviews were conducted, the overall non-specific benefits, interventions and cost savings were higher.
The project encouraged joined up working between the 2 sectors of the NHS and identified gaps in processes and communications. Elderly care pharmacists observed more confidence in GPs to act on recommendations made by them with the knowledge of additional support from BSMFHT. They no longer cited the need to send back to consultants for review. Carers in the home observed visible benefits of reducing antipsychotic prescribing such as reduced drowsiness and 'hangover' symptoms.
Due to the success of the project, it was expanded to include all residents of care homes with dementia, regardless of medication prescribed. The ECT were able to develop bespoke training materials to share with care homes, including sleep records and non-pharmacological interventions for BPSD. The goal being to educate homes into requesting medication less and choosing more appropriate management techniques.
