DH orders immediate review of care home prescribing

GPs face tough scrutiny of their prescribing for elderly people after the Department of Health ordered a safety review of the use of drugs in care homes.

The Department of Health has instructed PCTs to conduct an immediate review of the safety of drug use in care homes through an NHS-wide alert issued this week.

The move is the first sign of the Government reaction to mounting concern over the widespread use of drugs – such as antipsychotics – and their effect on care home residents.

The alert – via the NHS Central Alerting System – comes after a Government-funded review found a high prevalence of medication errors in care homes.

It also comes in advance of a major investigation by the CQC later this year into the use of drugs in care homes, specifically focusing on medicines management by GPs, care homes and PCTs.

The DH alert calls for ‘immediate action’ from PCTs and an ongoing audit of how GPs prescribe and review patients on controversial drugs, such as antipsychotics and benzodiazepines.

It urges ‘joint working’ with GPs, pharmacists and social care providers to review the prescribing and administration of medication to older people in local care homes and an audit of on-going progress.

‘PCTs should work with their primary medical care contractors, providers of pharmaceutical services and social care partners to determine how medication errors in care homes for older people can be reduced,’ says the alert.

A DH spokesperson said the alert was sent following the findings of a Government-funded study conducted by independent experts last year. This showed on any one day seven out of 10 care home residents experienced at least one medication error and there was potential for ‘serious harm’.

‘The DH would like PCTs to collaborate with all primary care providers, including GPs, to work together to review the safety of local prescribing, dispensing, administration and monitoring of medication to older people in care homes.’

‘A primary aim is to ensure adequate, sufficiently frequent and regular clinical review and monitoring of medication therapy, whether by GPs or pharmacists,’ he said.

The move comes after the Government promised to introduce strict curbs on GP antipsychotic prescribing for residents in care homes, following a report published in November last year linking the medications with 1,800 additional deaths a year.

The move has greatly concerned GPs. Dr Siraj Shah, a GP in Gravesend, said reviewing all the patients in his local care homes would be impossible.

‘When patients come out of hospital, they are on a concoction of medicines prescribed by junior doctors and consultants and who is going to follow this up? It is a lot of time.’

‘There is no doubt that these patients need regular monitoring and follow-up, but GPs do not have the resources or the time to do it.’

‘My view is the PCTs should appoint doctors with the responsibility of reviewing the medication of patients in care homes,’ he said.