Structured scrutiny could reduce drug side effects for people with dementia

A new study by Swansea University academics of people with dementia who live in care homes and have been prescribed medicines for their mental health, has found that structured scrutiny by their nurses has led to improvements in prescribing practice and pain management and greater awareness of adverse side effects.

Dementia care

The study, published in PLOS ONE, conducted by a team from the University’s College of Human and Health Sciences and the Medical School, looked at whether enhanced nurse-led monitoring of medication side effects could help reduce these effects, also known as preventable Adverse Drug Reaction (ADRs).  ADRs are known to have significant impacts on patients and the NHS, and result in:-

  • 5-8% of UK unplanned hospital admissions¹
  • 20.8% (60/290) of preventable emergency re-admissions within one year of discharge² 
  • 4-6% of UK hospital bed occupancy³ 
  • £1-2.5bn in annual costs to the NHS4  

Study

The research team focused on a sample of 41 patients living in five care homes who had been prescribed medication in three key groups: -

 

  • antipsychotics
  • anti-epileptics
  • antidepressants

The nurses that took part in the study followed the West Wales ADR (WWADR) Profile for Mental Health Medicines with their patients. This helped provide them with a structured framework for routine nursing care, aiming to:-

  • minimise ADRs without compromising the benefits of medicines 
  • identify, monitor and address any possible adverse drug reactions associated with medicines prescribed for mental health 
  • ensure problems are communicated to prescribers
  • facilitate shared decision-making with service users and within the multi-disciplinary team

Results

The study found that introducing the WWADR Profile for Mental Health Medicines could help improve the quality and safety of care for people living with dementia. 

Using the WWADR Profile could help increase professionals’ and patients’ awareness of ADRs. It would also address the concerns of public bodies over side-effects or under-reporting of ADRs1 or suboptimal medicines’ management (for example, the Trusted to Care Report5). It could also help to improve:-

  • the pain management of people with dementia
  • proactive and prompt sharing of prescribing information when patients are transferred between care settings
  • the implementation of recommendations from inquiries into health care failings5,6.

Dr Sue Jordan who led the study said: “We found that increased monitoring and intervention is effective low cost, low risk and convenient for service users and professionals. It offers potential for cost savings and increased quality and safety of care. It is useful to point out that profiles do not replace clinical knowledge and experience, but they bring together information on signs and symptoms in a succinct, formal assessment, and suggest solutions to problems that could be related to prescribed medicines. We now need larger, multicentre trials to examine long-term effects of structured medicines’ monitoring on clinical outcomes, nurses’ workloads, and bridging the gap between patients and prescribers.”

The study can be viewed here.

¹ NICE Medicines & Prescribing Centre. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. NICE guideline 5. NICE, London. 2015.Available at:  http://www.nice.org.uk/guidance/ng5/evidence/full-guideline-6775454 (accessed 04 June 2015).
² Davies et al 2010 Davies E.C., Green C.F., Mottram D.R., Rowe P.H. & Pirmohamed M. Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission. British Journal of Clinical Pharmacology. 2010; 70 (5), 749-55. DOI:10.1111/j.1365-2125.2010.03751.x.
³ Pirmohamed et al 2004 Pirmohamed, M., James, S., Meakin, S., Green, C., Scott, A. K., Walley, T. J., & Breckenridge, A. M. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004; 329(7456), 15-19.
4 Frontier Economic. Exploring the costs of unsafe care in the NHS: a report prepared for the department of health, Frontier Economics, London. 2014. Available at: http://www.frontier-economics.com/documents/2014/10/exploring-the-costs-of-unsafe-care-in-the-nhs-frontier-report-2-2-2-2.pdf (accessed 04 June 2015).
5 Andrews J, Butler M. Trusted to Care An independent Review of the Princess of Wales Hospital and Neath Port Talbot Hospital at Abertawe Bro Morgannwg University Health Board People, Dementia Services Development Centre, the People Organisation. 2014. Available at:  http://wales.gov.uk/docs/dhss/publications/140512trustedtocareen.pdf (accessed 04 June 2015). 
6 Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive Summary. (Online).  Available at: http://www.midstaffspublicinquiry.com/report (accessed 04 June 2015).