New drugs scheme is making a difference to elderly
Older people can suffer unwanted side-effects from the overuse of medication. But a new scheme from Swansea University is aiming to reduce this problem and allow individuals to live safely for longer...
One of the many challenges facing the NHS today is tackling the adverse side-effects caused by medication prescribed and administered to its patients.
But now a Swansea University initiative is addressing the issue, helping to improve life-threatening problems, reduce pain and boost quality of life.
Sue Jordan, professor of medicines management and health services research at the university’s College of Human and Health Sciences, said: “More than 50% of care home residents are being prescribed medicines they don’t need or that don’t 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 solve. The overuse of medicines for older people is a complicated issue.
Some may have been taking the same medicines at the same doses for years, even after an underlying problem has been resolved.
Professor Jordan is part of the team behind ADRe – the Adverse Drug Reaction profile. This is a straightforward checklist that can be completed by nurses and then discussed by all the health professionals involved with an individual patient’s care and responsible for prescribing.
It helps professionals identify 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.
Adverse drug reactions (known as ADRs) occur when medicines or combinations of medications produce unwanted – and sometimes lethal – side-effects.
In Welsh “adre” means “homeward”, to a place of safety where you can enjoy your health and wellbeing, and this sums up the ethos behind ADRe, said Prof Jordan.
Using ADRe takes about 15 to 20 minutes and sees complex information on medicines combined in a checklist providing advice on common problems.
This helps nurses recognise and act on any adverse drug reactions they spot, including pain, aggression, sedation, dry mouth or peptic ulcers.
Professor Jordan said: “This greatly enhances the administration of medicines and, by capturing an individual picture of the patients’ health and wellbeing, it prompts prescribers to refine dosages as required. Then after a month the profile is repeated to ensure no new issues have arisen.”
One care home resident interviewed as part of the project said they were grateful to see the introduction of closer medication monitoring.
He said: “I am handed a little cup in the morning and they say ‘here take them.’ I think we should be more in contact with nurses or doctors, to have a talk with them and find out what tablets we are on and what they’re for.
“I mean, we can’t sit here and be dished out tablets and not know what they’re for but that’s what we’re doing.”
A spouse of a care home resident said before ADRe they were often left feeling frustrated by doctors who prescribed drugs without considering what impact they might have.
She said: “The psychiatrist relies very heavily on what the care staff say. So this might actually strengthen what the staff are able to say about a medicine’s impact.
“If you are not monitoring these kind of things you can easily have disasters, people made ill, mistakes made or valuable information about somebody’s condition not being properly picked up on, so this is very important.”
Besides the health benefits to patients, Prof Jordan explained the financial burden caused by adverse reactions.
“With preventable ADRs responsible for 5-8% of unplanned hospital admissions in the UK, and costing the NHS up to £2.5bn every year, it is crucial that healthcare organisations take advantage of tools which can help improve how medicines are managed.”
The ADRe profile has already been having an impact on health policy planning.
A Welsh Assembly report seeking changes to the prescribing of antipsychotic medicines in Welsh care homes highlighted ADRe and its positive results, calling for it to be implemented across Wales.
Professor Jordan added said: “Our research and work in care homes means that we now have enough evidence to show the way ADRe benefits patients, and there are no good reasons why it should not be adopted for all care home patients.”
She said most recently collected data showed that:
■ In a study of 30 patients ADRe identified pain in eight, shortness of breath in six, and in each case, the problem was addressed;
■ When ADRe is used, doses of sedative medicines were reduced, and patients’ confusion is alleviated;
■ Where ADRe has been used long-term, admissions for falls and fractures have reduced to almost zero; ■ ADRe can be used routinely as part of standard care and treatment planning review process.