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

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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.

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