New way of monitoring medicines could vastly improve lives of people in care homes

November 6, 2018 by Sue Jordan And Mel Storey, The Conversation
Credit: wavebreakmedia/Shutterstock

More than 50% of care home residents are being prescribed medicines that they do not need, or which do not properly address their health problems. Antipsychotics, for example, are often overused to treat the behavioural and psychological symptoms of dementia.

But this problem is not easy to remedy. The overuse of medicines for older people is an issue of multiple layers. Some may have been taking the same medicines at the same doses for many years, even when the underlying problem has resolved. There is a reluctance to stop prescribing based, in part, on the potential risks of medication withdrawal, as well as the resources needed to manage any symptoms that re-emerge (the British National Formulary recommends monitoring patients for two years after discontinuation of medication).

This is not just a matter of drugs being taken unnecessarily, a big problem associated with the prescribing and taking of inappropriate medication is . These -related side effects account for 5-8% of unplanned UK hospital admissions – most of which are preventable. These also cost the NHS an estimated £1-2.5 billion every year. It is a situation that has persisted for over a decade.

Adverse drug reactions from mental health medicines can be life threatening (for example, they can cause heart problems), debilitating (causing drug-induced Parkinsonism, muscle coordination problems, blood pressure falling on standing) or subtle (with symptoms such as dry mouth, incontinence). They may also be mistaken for signs of ageing or an underlying disease. They can be overlooked too, leading to behaviour problems, poor food and/or fluid intake, tremors, restlessness, sedation, pain, double incontinence or other problems – all of which can cause loss of comfort and dignity.

Some 18% of the 13,699 incident reports and 24% of 996 deaths or serious harms in UK primary from 2005-2013 were attributed to prescription medicines, mainly from avoidable adverse reactions. And this was largely due to inadequate monitoring, communication or decision making. At present there is no comprehensive system to address these problems, so we suggest closing this care gap with a new, formalised and structured profile of patient checking and medicines monitoring, called ADRe Profiles.

Straightforward monitoring

While most evidence of harm comes from looking over large databases after the event, our system is forward looking. The profiles aim to prevent adverse reactions through regular monitoring, and by fixing problems at an early stage as an integral part of care, before they can become serious.

It is essentially a straightforward checklist, with supporting information, to be completed and then discussed by all health professionals involved with in a patient's care. It helps professionals identify and address any undesirable side effects of medicines, and ensures they are dealt with before they become serious enough to impair people's lives or require urgent care.

We have been working with ten care homes across South Wales to test the profiles, and found that in each use, a problem was highlighted or identified. If implemented nationwide, this would provide robust data to identify the true scale of the problem of unnecessary prescribing to older people, while at the same time helping those in need.

The care home professionals who used the profiles said that they gave them confidence to question and communicate with prescribers. Care home managers, meanwhile, reported reductions in doses of antipsychotic medicines, as a direct result of use of the profile system, which led to residents being less sedated, sleeping better and feeling brighter, and having fewer problems.

As well as helping to prevent , in some patients, the profiles identified and addressed previously unsuspected problems. These included aggression (and its causes), heart problems, seriously high blood pressure, Parkinsonism due to prescribed medicines, pain (from joints, mouth ulcers and poorly fitting dentures, for example), risk of falls, chest pain, nausea and pancreatitis caused by the drug valproate. No harms have been reported from use of our system, and everyone has benefited to some extent.

Time and money saved

ADRe Profiles take 10-30 minutes to complete and become easier with repeated use and experience. This costs about £20 in a junior nurse's time. By contrast, if a care home resident falls and breaks a leg, for example, a complicated fracture can cost £14,163 in the first year and £16,302 in the first two years following the incident.

GPs and specialists who prescribe typically see care residents very briefly for review. But those working in care homes see the subtle, gradual, unpleasant adverse effects of medicines everyday. And by using the profiles, these professionals can contribute to medicines management and prescribing decisions.

The benefits here are clear. The main barrier is simply staff taking time to become familiar with the system, and balance their priorities. The system closes the medication loop because it gives professionals – who really know the patients best – a voice, a strategy and knowledge to raise their concerns with prescribers.

Explore further: Nurse-led monitoring improves the care of patients prescribed mental health medicines

Related Stories

Nurse-led monitoring improves the care of patients prescribed mental health medicines

November 16, 2016
New research has found that nurse-led medicines' monitoring can prevent serious adverse side effects of medicines prescribed to people with mental health problems and previously unnoticed health problems in patients can also ...

Medication-related harm in older adults is common, costly, and preventable

May 23, 2018
New research indicates that harm from medicines is common in older adults following hospital discharge, and it results in substantial use of healthcare resources. In the British Journal of Clinical Pharmacology study, medication-related ...

New tool developed to reduce adverse drug reactions

February 22, 2017
Researchers at the University of Liverpool, Alder Hey, University of Central Lancashire and University College London have developed a new tool to help avoid adverse reactions to medicines.

New study finds patients want more information about their medicine

September 4, 2018
Many patients want more information on the medicines they're prescribed and greater say in the brands they use, the first major study of the burden of long-term medicine use has concluded.

More than 200 million medication errors occur in NHS per year, say researchers

February 23, 2018
A study has revealed an estimated 237 million medication errors occur in the NHS in England every year, and avoidable adverse drug reactions (ADRs) cause hundreds of deaths.

New solution to reduce medicine errors in elderly

July 2, 2012
(Medical Xpress) -- Many older people at high risk of medicine-related problems are not receiving medication reviews when referred to aged community care services, new research has found.

Recommended for you

Youth dating violence shaped by parents' conflict-handling views, study finds

November 16, 2018
Parents who talk to their children about nonviolent ways of resolving conflict may reduce children's likelihood of physically or psychologically abusing their dating partners later—even when parents give contradictory messages ...

A low-gluten, high-fiber diet may be healthier than gluten-free

November 16, 2018
When healthy people eat a low-gluten and fibre-rich diet compared with a high-gluten diet, they experience less intestinal discomfort including less bloating. Researchers at University of Copenhagen show that this is due ...

Why we shouldn't like coffee, but we do

November 15, 2018
Why do we like the bitter taste of coffee? Bitterness evolved as a natural warning system to protect the body from harmful substances. By evolutionary logic, we should want to spit it out.

Dietary fat is good? Dietary fat is bad? Coming to consensus

November 15, 2018
Which is better, a low-fat/high-carbohydrate diet or a high-fat/low-carbohydrate diet—or is it the type of fat that matters? In a new paper featured on the cover of Science magazine's special issue on nutrition, researchers ...

Colder, darker climates increase alcohol consumption and liver disease

November 14, 2018
Where you live could influence how much you drink. According to new research from the University of Pittsburgh Division of Gastroenterology, people living in colder regions with less sunlight drink more alcohol than their ...

Survey reveals how we use music as a possible sleep aid

November 14, 2018
Many individuals use music in the hope that it fights sleep difficulties, according to a study published November 14 in the open-access journal PLOS ONE by Tabitha Trahan of the University of Sheffield, UK, and colleagues. ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.