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DH orders immediate review of care home prescribing

By Nigel Praities

GPs are to be told to immediately audit all their prescribing to patients in care homes and will face an investigation by the health and social care regulator, after the Department of Health ordered an urgent safety review.

The DH has instructed PCTs to work with GPs, pharmacists and social care providers to assess the quality of prescribing, after a Government-funded study published last year found evidence of frequent prescribing errors.

On any one day seven out of 10 care home residents experienced at least one medication error, with potential for ‘serious harm', research from independent experts has found.

The new safety review – issued for ‘immediate action' via the NHS Central Alerting System – is a sign of mounting Government concern over prescribing and quality of care in residential care homes.

It follows the instructions before Christmas for GPs to audit their prescribing of antipsychotics and benzodiazepines in patients with dementia, after a report in November last year linked the medications with 1,800 additional deaths a year

The alert 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,' it says.

And the safety review is to be supplemented with a major investigation by the Care Quality Commission this year into the use of drugs in care homes, specifically focusing on medicines management by GPs, care homes and PCTs.

A Department of Health spokesperson said: ‘A primary aim is to ensure adequate, sufficiently frequent and regular clinical review and monitoring of medication therapy, whether by GPs or pharmacists.'

But the move has greatly concerned some 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.

PCTs have been told to review the safety of prescribing in care homes Pressure grows on care home prescribing

Jun 08: Ministers announce a review of use of anti-psychotic medication by GPs in patients with dementia

Jan 09: Study shows antipsychotic drugs substantially raise the long-term risk of mortality in patients with Alzheimer's disease

Sept 09: NICE unveils plans for QOF indicators to incentivise GPs not to prescribe antipsychotics

Nov 09: Government accepts findings of a report calling for strict curbs on GP use of antipsychotics in patients with dementia, after it linked the treatment with 1,800 deaths a year

Jan 10: Government orders immediate review of care home prescribing


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