The use of strong sedative injections on dementia patients is meant to be a last resort – a medical backstop used only when all other options to calm a distressed patient have failed.
But it has now emerged that this powerful and “outdated” method of tranquilisation was being used with what charity leaders described as alarming frequency on patients in Jersey’s General Hospital, sparking serious safety concerns and prompting a major crackdown by health officials last year, including a new drug monitoring system and extra training.
The issue only came to light for the first time this week in the recently-published Health and Care Jersey Quality Account 2024, which concluded that care for dementia patients had not been “consistently optimal”.
It 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.
Rapid tranquillisation is medically defined as the administration of sedative medication by injection.
According to national guidelines, rapid tranquilisation should only be used as a last resort when other psychological and behavioural approaches have failed to calm a patient.
“Significant risks like increased confusion and falls”
Claudine Snape, CEO of Dementia Jersey, said that the charity was “alarmed” by the frequent use of rapid tranquilisation medications in the General Hospital.
She said: “When we wrote the Dementia Strategy with the Government in 2023, many people with dementia and their carers were experiencing poor hospital care, which informed the strategy’s priorities.
“We were alarmed by the frequent use of rapid tranquilisation medications, which should only be a last resort due to significant risks like increased confusion and falls.”
But Ms Snape said it was “reassuring” that “widespread efforts” have now been made to reduce the use of rapid tranquilisation, and improve the quality of dementia care.
The report explained that training and education has been provided to hospital staff on the rapid tranquilisation policy and the importance of reporting such incidents.
Automated reports on rapid tranquilisation use are sent to lead nurses and clinicians each day to “provide assurance of appropriate usage”.
A monthly report is also now produced and reviewed by the hospital dementia steering group.
Ms Snape said: “We welcome the dementia training programme, which we understand was of very high quality; new guidelines for care of people with delirium and Jersey’s inclusion in the National Audit of Dementia, overseen by the Hospital Dementia Steering Group.”
“Significantly detrimental impact” on patients
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.
She explained that a working group was “immediately” set up to tackle the issue.
“The group worked hard to identify the issues, began daily reporting, regular audits, and training has been provided by specialist dementia nurses,” she said.
“In addition, the group gathered regular data from the pharmacy about what was being prescribed, where, and for what purpose.
“As a result, clear guidelines were developed and a robust framework was put in place.
“This should give patients and their carers great comfort as it means that the process is constantly monitored and any issues can be immediately addressed.”
The Health and Care Jersey Quality Account 2024 estimated that, at any one time up, to one-in-four acute hospital beds are occupied by people living with dementia.
In Jersey, people with dementia remain in hospital for twice as long as those people without dementia, and up to two-thirds of delayed discharges from acute wards relate to people with dementia.
Ms Winchester said that it is crucial for dementia patients to avoid prolonged hospital admission.
“Not only are such patients at risk of hospital acquired infections which increase the risk of delirium, but they also risk more quickly losing knowing who they are or where they are, loss of orientation, loss of mobility and loss of confidence from being in a strange environment which as you can imagine is noisy, confusing, and can be perceived as frightening,” she said.
“Urgent” need for dementia funding
Meanwhile, the Dementia Jersey CEO said that there was an urgent need to secure funding for the Jersey dementia strategy to improve patient care.
It come after it last year emerged that no funding was allocated to governmental strategies aimed at preventing suicide and supporting individuals with dementia, ADHD, and autism.
Although the Health Department requested £1 million in funding to implement strategies for dementia, neurodiversity, and suicide prevention, the funds were never allocated – meaning that the Adult Mental Health Service does not have the money to implement proposed actions and recommendations.
Ms Snape explained: “We are developing a new integrated care pathway for islanders with dementia from point of referral for assessment to end of life and urgently need funds for staff to deliver it.
“Without resources, we risk missing a prime opportunity to transform dementia care in Jersey.”
The report stated that a review of the use of psychotropic medications for people admitted to the General Hospital was completed in the start of the year, and an in-depth audit based on the National Audit of Dementia Psychotropic Medications was also completed in 2024.
Learning from the audit was due to be shared with clinicians last month.
A spotlight audit was completed in July 2024 reviewing care of inpatients with dementia dementia, with a repeat spotlight care audit is planned for February 2025.
Express has asked the Government for a copy of these audit documents and their findings.