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Reducing medication for people living with dementia

HC-One Scotland and the Care Inspectorate have worked together on a design aimed at reducing psychoactive drug for people who are living with madness. One of the successful case studies from the design will feature in the ten- time delivery plan for the Scottish Government’s new Dementia Strategy. Through this design, they aimed to reduce reliance on routine and as needed psychoactive drug for the operation of stress for people with dementia.

reducing medication chart

The case study from the project that will be included in the delivery plan for the Scottish Government’s ten-year dementia strategy is a personal care story from Hillside View Care Home.

Colleagues recognised height of care staff as a contributing factor which has resulted in better personal care for a resident living with dementia at the home with the resident now accepting personal care on a regular basis without becoming stressed.

The resident had increased in weight, became more engaged in activities, sitting for meals in the dining room and family and colleagues have noted the resident being more relaxed and content with the resident now accepting care following receiving a reduction in medication. 

The project was rolled out across eight HC-One Scotland care homes in total, over nine months (March 2023 – November 2023) in conjunction with the Health and Social Care Improvement Team in the Care Inspectorate and resulted in improved outcomes for residents living with dementia.

All eight HC-One Scotland care homes opted to take part in the programme and the care teams were passionate about learning and sharing what they learnt with others to address common issues with dementia care and use of psychoactive medicines.

The rollout of the ‘Reducing Inappropriate Psychoactive Medication For People Living with Dementia’ project was initiated following Katy Jenks, Dementia Care Manager (Nursing) at HC-One, speaking with Dr David Marshall, Senior Improvement Adviser (Pharmacy) at the Health and Social Care Improvement Team in the Care Inspectorate, for pharmacy advice. 

The discussion was in response to HC-One Scotland Care Home Managers experiencing some challenges with getting medications reviewed, with some care homes finding that they were caught in the middle between their GP and Mental Health Services.

This meant that some residents could be on medicines they no longer needed.

These were issues facing many areas of the social care sector, not just HC-One Scotland. The current system needed to change as it was not serving the needs of residents well.

HC-One Scotland wanted to support the health and social care system and achieve better outcomes for people living with dementia, and for staff to be more confident to call for change and challenge the status quo.

The project also looked at reducing the reliance of staff on using medicines as a first line approach to managing symptoms.

Upon starting the project, the teams started seeing results. For example, a resident who was initially taking a high level of psychoactive medication and, as a result, was heavily sedated, had their psychoactive medicines withdrawn in a careful and controlled way, which resulted in the resident becoming reengaged with the environment.

This initially led to an increase in some stress and distress behaviours. However, the team in the home was able to observe that behaviours increased during sunset and the resident felt threatened by people following them.

Through identifying the ‘why’, this allowed the team to build a tailored therapeutic support plan for the resident to provide meaningful occupation and engagement. 

This included fitting a blind to the resident’s room to reduce hallucinations from the shadows from the sunsetting and adding a door alarm that is linked to the nurse call so that the resident could have privacy in their room. 

Taking this approach combined with a reduction in prescribing and the use of psychoactive medicines meant that the outcome of this work for the resident now allows them to run a gardening club and they take the lead daily in what they want to do, with staff supporting rather than managing them.

The resident is mobilising and eating independently and supporting themselves with personal care and have a better quality of life for resident and family.

Fullarton Care Home in Irvine, Ayrshire, who took part in the project wanted to have all residents who have had a change in health needs or who are now on End of Life care to have psychoactive medication review to prevent anyone being on psychoactive medication longer than they are required.

The team identified all those with changing needs that needed a review and obtained an understanding of why each person was prescribed psychoactive medication.

They spoke to a GP and managed to get the medication reviewed which has resulted in a 65% reduction in whole unit PRN (medication that is not required on a regular basis) psychoactive doses per month and an 87% reduction in the whole unit number of anti-psychotic items. 

A relative at Fullarton Care Home, commented:

“The feisty wee woman I knew is back, every time we used to visit; she was sleeping. That is no longer the case she is now running this unit.”

Charlotte Beaumont, Home Manager at Fullarton Care Home, said:

“Staff are now asking questions as to why people are on certain medication and if it needs reviewed. This has been a big change as before I would have had to have started these conversations.” 

HC-One Scotland are now planning to roll out the project to other cohorts of care homes to try and ensure sustainability. The second cohort of the project is planned to start in March 2024 and the third cohort is aimed to commence in June 2024.

Katy Jenks, Dementia Care Manager (Nursing) at HC-One said:

“It was a very inspirational project to cohost with the Care Inspectorate, watching frontline staff embrace a new way of working that had positive impacts on people in our care and wanting to share this with others reminded why I wanted to be a nurse and work in dementia care. They embraced finding the “why” for behaviours and adapt care so that medication was only ever a last resort resulting on better quality of life outcomes for people in our care and improved job satisfaction for staff who work in these homes.”

August LTD
Grahame Gardner
Mr Trax Curtain & Blind Solutions
Care Show London
Inspired Inspirations
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