Commitment to review care for people with dementia on antipsychotic medication

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The Dementia Action Alliance has launched a call to action on the use of antipsychotic drugs for people with dementia:

All people with dementia who are receiving antipsychotic drugs should receive a clinical review from their doctor to ensure that their care is compliant with current best practice and guidelines and that alternatives to medication have been considered by 31 March 2012.

There are about 750,000 people with dementia in England and it’s estimated that around 20% (180,000) are currently being prescribed antipsychotic medication.

In 2009 the Department of Health published the Bannerjee report which highlighted these risks, and concluded that antipsychotics are too often used as a first-line response to behavioural difficulty in dementia rather than as a considered secondline treatment when other non-pharmacological approaches have failed.

The call has identified 8 key groups of people, and individual commitments for each group, in order to achieve the overall goal:

People with dementia, their carers and families

  • We commit to proactively seeking a conversation with my (our) GP to review care and agree a personalised care plan (in line with best practice).

Commissioners in health, social care and GP commissioning

We commit to:

  • improving the quality and experience of care for people with dementia (and their carers), by commissioning a whole systems approach to dementia
  • ensuring through effective evidence-based commissioning, that we support providers to minimise the need for antipsychotic drugs, and in addition ensuring that prescribing is in line with NICE guidelines across the health and social care system.

General practitioners and primary care teams

  • We commit to identifying and reviewing their patients who have dementia and are on antipsychotics with the purpose of understanding why antipsychotics have been prescribed.
  • Working in partnership with the person with dementia, their family and carers and their medical colleagues in psychiatry to establish whether or not the use of antipsychotics is inappropriate and whether or not it is safe to begin the process of discontinuing their use and to establish that access to alternative interventions can be secured

Hospital doctors and multidisciplinary teams

  • We commit to carefully considering whether or not a prescription for antipsychotic medication is appropriate for someone with dementia who is in hospital and reviewing the prescription on transfer or discharge from hospital to another setting

Leaders of care homes

  • We commit to identifying all people prescribed antipsychotic medication and to documenting and delivering an evidence-based, personalised care plan developed in partnership with the individual, their family and the multidisciplinary clinical team

Pharmacists

  • We commit to reviewing the people under my care to identify those who are prescribed antipsychotic medication and working in partnership with my prescribing and other healthcare colleagues to review each individual by 31st March 2012

Psychiatrists and mental health teams

  • We commit to reviewing the cause(s) of disturbed behaviour before initiating or continuing antipsychotic treatment

Medical and nursing directors

  • We commit to providing clinical leadership and governance to ensure the review of antipsychotic prescriptions and care plans for people with dementia and ensuring alternatives are in place by 31st March 2012

Links

  1. NHS Institute for Innovation and Improvement – The Right Prescription: a call to action on the use of antipsychotic drugs for people with dementia (PDF).
  2. Dementia Action Alliance – The National Dementia Declaration.
  3. Alzheimer’s Society – Antipsychotics.
  4. Department of Health – Report on the prescribing of anti-psychotic drugs to people with dementia, 12 Nov 2009.
  5. Skills for Care, Skills for Health, Department of Health – Common core principles for supporting people with dementia: a guide to training the social care and health workforce (PDF), 9 Jun 2011.
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