Almost 70% of dementia patients prescribed mood-altering medications in Jersey’s General Hospital did not have the reasons documented, Express has learned.
Psychotropic medications are drugs that affect a person’s mind, emotions, or behaviour, commonly used to manage distressing symptoms like agitation, anxiety, or hallucinations in dementia patients.
The audit report on psychotropic medication prescribing practices in dementia patients was published following a request made by Express under the Freedom of Information Law.
“Inadequate” documentation
The report found that the documentation of psychotropic medications was “inadequate”, with just 31% of new medications having the target symptom recorded.
“Additionally, there was limited evidence of discussions with patients or relatives regarding the risks or potential side effects of these medications,” the document said.
“Best practice dictates that these conversations should occur, whenever possible, before initiating new psychotropic treatments.
“Especially in a population of patients with dementia who are highly likely to have a nominated lasting power of attorney for health, who should be involved in decision making around changes in care.”
The audit also revealed that only 10% of discharge letters documented changes in psychotropic medications, and communication with community services was identified as a “key challenge”.
The report said: “The low rate of documented medication changes in discharge letters highlights a need for improvement.
“Without clear communication, community healthcare providers, who often continue managing long-term psychotropic prescriptions, may struggle to understand the rationale for medication changes, potentially compromising patient care.”
A “gap” in post-discharge care
The review also described a “gap” in post-discharge care for dementia patients, with
only 13% of patients having a documented follow-up with mental health services after leaving hospital.
However, the audit acknowledged that “not all patients with dementia who are admitted to the hospital require follow-up with mental health services upon discharge”.
The report found that zopiclone was the second most frequently prescribed new medication (22%), despite its documented risks of drowsiness, falls, and cognitive impairment.
Previous reviews had already flagged that zopiclone is “frequently used” in the General Hospital, the report said.
The audit aimed to compare prescribing practices in Jersey to UK national averages.
It was was commissioned by the Dementia Steering Group, and focused on a randomised sample of 100 inpatients admitted to the General Hospital between February 2022 and February 2023.
The report found that 77% of psychotropic prescriptions were initiated before hospital admission, mirroring UK averages.
However, the Jersey General Hospital had a higher proportion of new prescriptions (23%) than the national audit.
The island also had a “slightly higher proportion” of hypnotics and anxiolytics, which include sedatives and anti-anxiety medications, being used on a regular basis.
Recommendations
The report called for a training programme for staff focusing on the appropriate use, benefits, and potential side effects of psychotropic medications in dementia care.
It also called for an “improved policy” that outlines “clear guidelines” for prescribing psychotropic medications.
“This policy should include specific protocols for communicating any changes in medication to primary care teams to ensure continuity of care,” the report said.
The audit called for changes to the hospital’s electronic prescribing system to ensure it captures information about the target symptoms for which psychotropic medications are prescribed, and the reasons for discontinuation of these medications.
It also recommended that the documentation of patients’ ethnicity on hospital system should be improved, and for another audit to be carried out in one year.
Patient safety events
Concerns regarding the use of strong sedatives on dementia patients came to light earlier this year when the Health and Care Jersey Quality Account 2024 was published.
The document concluded that care for dementia patients had not been “consistently optimal” and revealed that the use of rapid tranquilisation led to a number of “patient safety events” – unexpected incidents which could have, or did, lead to harm for those receiving care, which are formally reported so that the service can learn from mistakes.
The report raised significant concerns regarding the care of dementia inpatients, and highlighted a lack of clear guidelines on the prevention and management of delirium –leading to an “inconsistency of approaches” in care and “limited awareness” of those at risk.
It also revealed that “patient safety events involving the administration of rapid tranquilisation medication” prompted a review of practices and the introduction of new training for clinical staff.
At the time, Dementia Jersey CEO Claudine Snape said the charity was “alarmed” by the frequent use of rapid tranquilisation medications in the General Hospital.
However, she said it was “reassuring” that “widespread efforts” had been made to reduce the use of rapid tranquilisation, and improve the quality of dementia care.
And mental health advocate Patricial Winchester, who is the CEO of charity My Voice, said that the use of rapid tranquilisation is an “outdated practice” which can have a “significantly detrimental impact on patients living with dementia”.
But Ms Winchester also praised the progress that has been made since this issue was identified last year, with a working group “immediately” set up to tackle the issue.
