Written Question · S4W-06729 · Session 4
What advice it has issued to GPs on (a) when antipsychotic medication should be prescribed to residents of care homes and (b) which medicat…
The question
To ask the Scottish Executive what advice it has issued to GPs on (a) when antipsychotic medication should be prescribed to residents of care homes and (b) which medication to prescribe.
The answer
The prescribing of antipsychotic medications in care homes and other settings will be informed by best clinical practice and by national SIGN guideline 86 on the management of patients with dementia, which includes evidence-based recommendations on interventions to manage challenging behaviour symptoms which can be associated with dementia. This guideline was reviewed in 2009. In addition, there were two major regulatory warnings, in 2004 and 2009, which cautioned that antipsychotics were associated with an increased risk of stroke and death in people with dementia. Evidence shows that both warnings had a effect on prescribing by GPs.
The dementia standards, published last year, state that NHS boards must ensure that systems are in place to ensure that capacity to consent to treatment (including the prescribing of psychoactive medication) is considered and that appropriate documentation is in place, in line with Part 5 of The Adults With Incapacity (Scotland) Act 2000. The Act says that if the person cannot give valid consent then the view of any proxy decision maker (a welfare power of attorney or welfare guardian) should be sought. A certificate of incapacity must be completed under section 47 of the AWI when someone lacks capacity to consent – this certificate authorised treatment and ensure treatment is given lawfully.
They also state that services must demonstrate knowledge of whether the person with dementia has appointed someone as their welfare power of attorney or if there is a welfare guardian, and that any challenging behaviour must always be addressed by means of an integrated assessment to establish the cause and put a care plan in place to manage it, in line with the relevant SIGN clinical guidelines.
We have a specific commitment in the national dementia strategy to reduce the inappropriate prescribing of psychoactive medication. We are currently considering the findings and recommendations of an academic report we commissioned into time trends in the prescribing of antipsychotic and other psychotropic medications to older people with dementia between 2001-11 and the report will inform a commitment to reduce inappropriate prescribing of psychoactive medication to be finalised this year.
Clinical decision-making in individual cases is taken by the relevant professional, and of course there are cases when the prescribing of psychoactive medication is appropriate and the best treatment option at that particular time, particularly when psychotic symptoms manifest themselves in behaviour which cannot be managed without medication. For example such drugs may be helpful for some in relieving symptoms such as agitation, delusions or hallucinations, and, although there are risks, where the prescribing of psychoactive medication is appropriate, clinical decision-making will always need to weigh any risk against the risks around not prescribing.
The dementia standards, published last year, state that NHS boards must ensure that systems are in place to ensure that capacity to consent to treatment (including the prescribing of psychoactive medication) is considered and that appropriate documentation is in place, in line with Part 5 of The Adults With Incapacity (Scotland) Act 2000. The Act says that if the person cannot give valid consent then the view of any proxy decision maker (a welfare power of attorney or welfare guardian) should be sought. A certificate of incapacity must be completed under section 47 of the AWI when someone lacks capacity to consent – this certificate authorised treatment and ensure treatment is given lawfully.
They also state that services must demonstrate knowledge of whether the person with dementia has appointed someone as their welfare power of attorney or if there is a welfare guardian, and that any challenging behaviour must always be addressed by means of an integrated assessment to establish the cause and put a care plan in place to manage it, in line with the relevant SIGN clinical guidelines.
We have a specific commitment in the national dementia strategy to reduce the inappropriate prescribing of psychoactive medication. We are currently considering the findings and recommendations of an academic report we commissioned into time trends in the prescribing of antipsychotic and other psychotropic medications to older people with dementia between 2001-11 and the report will inform a commitment to reduce inappropriate prescribing of psychoactive medication to be finalised this year.
Clinical decision-making in individual cases is taken by the relevant professional, and of course there are cases when the prescribing of psychoactive medication is appropriate and the best treatment option at that particular time, particularly when psychotic symptoms manifest themselves in behaviour which cannot be managed without medication. For example such drugs may be helpful for some in relieving symptoms such as agitation, delusions or hallucinations, and, although there are risks, where the prescribing of psychoactive medication is appropriate, clinical decision-making will always need to weigh any risk against the risks around not prescribing.
In the Official Report
No contribution in the Official Report cites S4W-06729 by reference.