P 16
Ymchwiliad i’r Adolygiad Blaenoriaethau ar gyfer y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon
Inquiry into the Priorities for the Health, Social Care and Sport Committee
Ymateb gan: Yr Athro Sue Jordan
Response from: Professor Sue Jordan
[Via email]
Priorities for Health, Social Care & Sport Committee Consultation
Use of antipsychotic medication in care homes
The Older People’s Commissioner and the Flynn Review [Opens in a new browser window] both highlighted concerns about the inappropriate use of antipsychotics to control the behavioural and psychological symptoms of people living with dementia. The Committee could seek to assess the scale of the problem, and examine possible solutions.
We have developed and tested an intervention which has been shown to reduce the use of sedative medicines, including antipsychotics, in care homes. Our intervention is the West Wales Adverse Drug Reaction (WWADR) Profile for mental health medicines (to be sent on request). It lists problems that might be associated with or exacerbated by these medicines, and asks nurses to monitor these and inform prescribers or pharmacists. We have shown in randomised controlled trials and observation studies that structured nurse-led medicines’ monitoring using the WWADR Profile benefits patients, for example, by reducing pain and sedation, encouraging behavioural interventions and identifying high risk cardiovascular conditions. Our trials indicate that the intervention does not cause harm, and there is potential for considerable cost saving. The comments of the care home managers, some papers, endorsements and our video are below.
I should like to discuss how our evidence-based solution could contribute to the consultation and be operationalized.
I look forward to hearing from you,
Professor Sue Jordan
Some key open access papers with links Jordan S, Gabe-Walters ME, Watkins A, Humphreys I, Newson L, Snelgrove S, Dennis M. (2015) Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial. PLoS ONE 10(10): e0140203. doi:10.1371/journal.pone.0140203 http://dx.plos.org/10.1371/journal.pone.0140203
Jordan S, Gabe M, Newson L, Snelgrove S, Panes G, Picek A, Russell IT, Dennis M. (2014) "Medication Monitoring for People with Dementia in Care Homes: the Feasibility and Clinical Impact of Nurse-led monitoring," The Scientific World Journal, vol. 2014, Article ID 843621, 11 pages, 2014. doi:10.1155/2014/843621. http://www.hindawi.com/journals/tswj/2014/843621/
Our video & website
http://www.swansea.ac.uk/wwadr/#
Care Homes Managers who participated in the RCT (Jordan et al 2015)
• Home Manager said " The profiles are very useful and have enabled us to review and discuss the medications with the GP and CPN. As a result, for example we have stopped some antipsychotic medications that the patient no longer requires”. (Wilson, Care Home Manager, Glan Garnant)
• Paula Aplin said " The WWADR profiles are really useful and the staff are more educated and informed about drug reactions. The increase in staff confidence has made a big difference to medication management for the service users in our care ”.
• Aldo Picek Clinical nurse manager said “The tool increased the nurse knowledge and improved attitudes towards accountability. Increased confidence helped to identify side effects and change medications”.
• Sue Levy the Home Manager said " I use the checklist routinely in my practice and for the few minutes it takes, it provides a patient centred care for the person which makes it worthwhile. It has made me reflect and think of things that I wouldn't have prior to using the profile".
The work is endorsed by Age Cymru. Age Cymru are supportive of this piece of research.
Alzheimer’s Society, Wales will be supporting our research in forthcoming discussions with Welsh Government.
Yr Athro Professor
Coleg y Gwyddorau Dynol a Iechyd College of Human and Health Sciences
Prifysgol Abertawe Swansea University
Abertawe SA2 8PP Swansea SA2 8PP
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