Antipsychotic drugs being inappropriately prescribed, finds report

Antipsychotic drugs are increasingly being used in care home settings to ‘manage’ challenging behaviour of people with dementia, a report by a National Assembly committee has concluded.

The Health, Social Care and Sport Committee wants the Welsh government to ensure that all health boards are collecting and publishing standardised data on the use of antipsychotic medication in care homes and report back to it on progress within 12 months.

It wants to make sure health boards are fully compliant with NICE guidelines on dementia, which advise against the use of any antipsychotics for non-cognitive symptoms or challenging behaviour of dementia unless the person is severely distressed or there is an immediate risk of harm to them or others.

In total, the committee made 11 recommendations, which included national standards for dementia-care training to be developed to equip care home staff with the necessary skills to deal with challenging behaviour. It also called for every person with dementia presenting challenging behaviour to receive a comprehensive person-centred care assessment of their needs.

It said ‘cultural and systemic changes’ are needed to ensure antipsychotic medications are prescribed appropriately.

During evidence the committee was told that medication reviews are not happening frequently enough for people with dementia, and that once medication is prescribed, including antipsychotics, it often rolls on with repeat prescriptions for long periods without being monitored effectively.

Staffing issues were also highlighted in the Use of antipsychotic medication in care homes report, with evidence from Social Care Wales pointing out that the sector was under pressure and staff, once trained, often moved to the health sector because pay and conditions were better.

‘We know that there are various good practice checklists that could be used by staff in care homes to identify the possible causes behind an individual’s behaviour,’ said Dr Dai Lloyd AM, chair of the Health Social Care and Sport Committee. ‘Yet we were told that antipsychotics are being used as a default position in care homes and some hospital wards, when people with dementia are difficult to deal with.

‘Unnecessarily medicating vulnerable people in care is a profound human rights issue which must be addressed.’

Welcoming the report, Older People’s Commissioner for Wales, Sarah Rochira, said: ‘Whilst it can be appropriate to use antipsychotic medication in some cases, the inappropriate use of these powerful drugs can have a devastating impact on older people and is quite simply unacceptable.

‘I expect, as will older people and their families across Wales, a positive response from the Welsh government and a commitment to take meaningful action in response to the committee’s recommendations to address the issues identified within the report.’