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Pharmacists should be “guardians of the appropriate use of antipsychotics in care home settings”, the Royal Pharmaceutical Society (RPS) in Wales told the Welsh Assembly on 5 October 2017.
Mair Davies, RPS director for Wales, and Wendy Davis, RPS member and mental health clinical board pharmacist at Llandough Hospital, were presenting evidence at the Health, Social Care and Sport Committee’s inquiry into the use of antipsychotic medicines in care homes. The inquiry was instigated by the committee in response to calls from the Older People’s Commissioner for Wales and the RPS Wales policy, Improving Medicines Use for Care Home Residents.
Antipsychotics are often prescribed to help manage the psychological and behavioural symptoms of dementia, but concerns exist over the side effects and efficacy of this ‘off-label’ use. Where antipsychotics are used, Wendy Davies told the Committee, this should follow collaboration between health professionals, patients and their carers to ensure that the prescription is appropriate and based on a thorough risk–benefit analysis.
Davies highlighted a case study in which a prescribing pharmacist, working with a dementia care advisor nurse, had withdrawn antipsychotic medication from 14 out of 18 care home residents with dementia.
Mair Davies also called for national standards for care home staff, to ensure uniformity in quality of care across Wales. Davies expressed concern that “Care and Social Services Inspectorate Wales have not mentioned medicines since 2007–2008 in their inspections … we don’t know if [training is] accredited, and nobody is inspecting what’s going on with medicines”.
A full transcript of the evidence session is available here.
Pharmacists in care homes
The Royal Pharmaceutical Society (RPS) believes that pharmacists should have an embedded role in care homes, with overall responsibility and accountability for medicines and their use. The Society has produced ‘Improving care in care homes: A briefing for policy-makers’, and has created an Ultimate Guide for pharmacists working in care homes.
An RPS England policy report published in 2016, ‘The Right Medicine: Improving Care in Care Homes’ stated that such a policy could save the NHS £60 million in the medicine budget, and £75 million in avoided hospital admissions.
The report, informed by results of a 2015 survey of pharmacists carried out by the RPS practice and policy team in England, led to the RPS England campaign ‘Pharmacists improving care in care homes in England’.
The campaign calls for each care home in England to have an accountable pharmacist who would be responsible for medicines optimisation in the home, including medicine reviews and protocols and policies around the home’s medicines system.
The campaign is supported by professional bodies including the Alzheimer’s Society, Age UK and the Royal College of General Practitioners (RCGP).
RPS Scotland has called for a pharmacist to be in every care home. Their 2012 report ‘Improving Pharmaceutical Care in Care Homes’, “strongly suggests that it is now time for the Scottish Government and NHS Scotland to commit to mandatory input from pharmacists providing pharmaceutical care to all care homes”. A joint action plan between RPS Scotland and RCGPs called for training programmes exploring how GPs and pharmacists can work together to improve care for care home residents.
Care homes are also part of RPS Scotland’s 2016 manifesto, ‘Right medicine – better health – fitter future’, which recommends “integrating a dedicated pharmacist role into care homes”. A pledge to support the greater use of pharmacists’ clinical skills – part of the manifesto – has been signed by 39 MSPs, many of whom signed it following an RPS Scotland exhibition in the Scottish Parliament on 7-9 March 2017.
In March 2016 RPS Wales launched its report on ‘Improving Medicines Use for Care Home Residents’, in response to concerns raised by the Older People’s Commissioner for Wales regarding the care delivered in care homes. RPS Wales led on the development of policy and recommendations, along with key stakeholders including the Royal College of Nursing (RCN), the RCGP, the Royal College of Psychiatrists (RCPSYCH) and Age Cymru.
The policy and dialogue created by RPS Wales has resulted in greater emphasis on the role of the pharmacist in Public Health Wales’ campaign on falls prevention, and RPS policy recommendations are included in the Alzheimer’s Society work on care homes. The policy has also led to more pharmacist-led medicines reviews of care home residents.
RPS Wales will give evidence on the use of anti-psychotic medication in care homes to the Health, Social Care and Sport Committee, in October 2018, and further work is planned with NHS Wales, the Welsh Government and the Older People’s Commissioner for Wales to implement the policy recommendations.
Read The Pharmaceutical Journal’ s special report on pharmacists in the care home.
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