Antipsychotics: person centered care vs roots and branches

When I visit one of the nursing homes in my area, I invariably have specific appointments in mind. Mr Smith or Mrs Brown have been referred, or are already known to community mental health services. Working in an advisory / consultancy / educational capacity other individuals are brought to my attention and this continues the person centered focus - at least at this level.

Keeping things person centered beyond that in assessment, care planing and intervention - is the real challenge. Actually there is another: even where staff are 'trained' and you observe staff -:- resident interactions you often see that (as for us all) there remain key things to learn.

I've visited a few homes to try to jump start an audit of antipsychotics and other drugs that can be so damaging to older adults - potentially fatal in fact as per evidence based findings and reporting in the media:

About 145,000 people with dementia are wrongly being prescribed powerful anti-psychotic medication which causes around 1,800 deaths a year ... The Times

The problem is recognized now as per the Department of Health's (2009) report:

Report on the prescribing of anti-psychotic drugs to people with dementia

The risks, care management and quality of life issues that arise have prompted some homes / organisations to pursue this internally. My manager Christine and I are working to put a 'pack' together and make connections with colleagues working in residential care / nursing home liaison.

It is essential to check that there is consistency, compliance and that reviews are comprehensive. What blood tests have been completed and exactly when? Have next-of-kin been made aware of the potential side-effects? How skilled are staff in dealing with these acute care challenges? Is there a need to 'fix' the care environment? Is this placement - despite being the individual's home - still appropriate? What specific staff awareness is needed to support any shared care protocol that is put in place?

The point here is that it can be surprising the drugs that do come to our attention. People move in from out of area; some individuals are self-funding so they may by-pass formal services; others are seen by locum doctors / out of hours services and subsequent follow-up may be missed. ...

So here it's not about Mr Smith or Mrs Brown in the first instance, even though that's the expectation when I first arrive. Clearly, this is going to take a dedicated approach away from the personal care problem solving - solution finding (fire-fighting!).

The summary care record could be a great help here and I wonder about searches conducted within primary care GP systems. IT systems aside, it's about turning up and engaging with the homes around a root and branches review of their Medication Administration Records Sheets (MARS).

Task driven - person centered care!