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Antipsychotic medication overprescribed in care homes, Boots audit reveals

Report says community pharmacy can help optimise medicine use in geriatric patients and praised its "active intervention" to reduce antipsychotics' use over a short period of time

Community pharmacists can reduce inappropriate prescribing of antipsychotic medication in care homes, an audit has shown.

More than a quarter of patients did not show sufficient symptoms to warrant regular treatment, Boots found in its two-year audit of 463 homes.

The risks of treatment – including side-effects, sedation, falls and cardiovascular events – outweighed benefits in two-thirds of 3,165 patients prescribed antipsychotic medicine, the multiple reported in results published last week (June 4).

Boots pharmacists, some of whom had received training from the Alzheimer's Society, discontinued treatment in 17 per cent of dementia patients. They worked with GPs and care-home staff to reduce dosage in over 20 per cent of cases, working in accordance to Nice guidelines.

The report's authors praised community pharmacists for their "active intervention" to reduce administered antipsychotics over a short period of time

More on care of the elderly

The rewards of care home pharmacy

The care home conundrum

Update: The facts about dementia

More than one antipsychotic was prescribed concurrently in 87 patients, and in two cases there was no written record of the antipsychotic drug being reviewed in the patient. The most commonly prescribed drug was quetiapine (42 per cent), a drug which the authors pointed out is unlicensed for the treatment of dementia. This was followed by risperidone, the only licensed treatment (16.8 per cent), and haloperidol (12.2 per cent).

The use of antipsychotics in dementia patients – who represent 60 per cent of care-home residents – leads to 1,800 deaths per year, the report highlighted.

The authors – Aileen Prentice, Boots care services operations manager, and David Wright, professor of pharmacy practice at the University of East Anglia – praised community pharmacists for their "active intervention" to reduce administered antipsychotics over a short period of time. They also recommended that care-home nurses "regularly question" antipsychotic medication scripts with community pharmacists.

The audit proved that commissioned pharmacy services could further help to improve the care of care-home patients while working with healthcare professionals, said a Boots spokesperson.

"The prescribing of antipsychotic drugs in people with dementia is associated with increased mortality and morbidity," said Alistair Burns, national clinical director for dementia at NHS England. "This exciting publication underscores the key role that pharmacists have in optimising prescription of medication in this potentially vulnerable population," he added.

Have you found similar issues in the care homes your pharmacy services - and how have you dealt with them?
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Miracure Pharmacist, Work for a health/commissioning consultancy company

wait until you see what is happening with boots pharmacy instore in a nhs trust in birmingham---------- paracetamol being taken off patients, nurses made to read patients notes because boots retail pharmacists are not trained to read them, no reference sources other than the bnf available for drugs in pregnancy tut tut ... no sops

only boots can get away with this ................

UKTIS exists for all healthcare professionals in the UK for advice on medicines in pregnancy.

Gerry Diamond, Primary care pharmacist

My experience of Boots is that it has been very professional in delivering services within NHS trusts and that they do a really good job too.


in the last half hour gerry, In the last 'alf hour you've done
so much boot-licking you could be going down with cherry blossom poisoning!

Gerry Diamond, Primary care pharmacist

Very worth audit......well done Boots again!

John Randell, Non Pharmacist Branch Manager

big pharmac has always had an agenda of pushing antipsycotic drugs to the masses regarless if the person needs it or not.The criteria for needing this medication seems to be more relaxed each year...

JUST BROKE UP WITH YOUR BOYFRIEND OR GIRLFRIEND DONT WORRY JUST TAKE A PILL FOR IT.......rather than deal with it.....pain, suffering and beareavement are a part of the human condition to numb those feeling with drugs seems to be taking away something very important...the ABILITY TO LIVE...what is life without such experiences.

John Randell, Non Pharmacist Branch Manager

oops comment was about anti-depressants but you get the gist

Le sigh. Big pharma conspiracies are so boring nowadays. Sad to see a health care professional belittling serious mental illness in such a way.

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