2048 Antipsychotic medication prescription in elderly patients in Royal Gwent Hospital, Wales
K Dineshkumar, D Duric, E B Peter- Geriatrics and Gerontology
- Aging
- General Medicine
Abstract
Introduction
he use of anti-psychotics is higher in older people than their younger adult counterparts due to high prevalence of dementia/delirium. Anti-psychotic drugs cause side effects which include cardiovascular, metabolic, extra pyramidal and risk of falls. So, we set out to do a QIP on antipsychotic medication prescription on our Geriatric wards comparing it with NICE guidelines.
Method
We had 2 approaches to use. Firstly, we prepared a check list for anti-psychotic medication monitoring according to NICE guidelines 2021 and we applied this retrospectively to our patients who had been initiated on anti-psychotics within the last year, the aim being to compare our practice with best practice. Secondly, we prepared a questionnaire for doctors to assess their knowledge about anti-psychotic NICE guidelines and distributed this to our junior doctors in RGH.
Results
• Main Indication for prescription was Behavioural and psychological symptoms of dementia (BPSD) - 94% of the time
• Risperidone was the most commonly prescribed (64%) antipsychotic.
• 83% of them had non-pharmacological methods tried before considering antipsychotic medications.
• 82% had their baseline ECGs checked and falls risk assessments done
• 35% had their lipids checked and 47% had their HbA1c checked
• 52% of the doctors were aware about NICE guidelines on prescribing anti-psychotic medications
• 70% of the doctors had knowledge about the side effects.
Conclusions
Our study showed the most commonly used antipsychotic drug was risperidone. We were good at documenting the indication, trying non-pharmacological methods and discussing side effects with patients/family. Hba1c, lipids and prolactin were not often checked, showing room to develop best practice. We are in the process of finalising stickers as a checklist when starting antipsychotics. To improve knowledge, we have presented the findings and aim to put up posters on wards and to do regular teachings.