Aggressive residents could be suffering a drug side effect, care home trial finds

Aggressive behaviour, poor food and/or fluid intake, restlessness, or other health problems in care home residents may be the result of an adverse drug reaction (ADR), a trial in 10 Welsh care homes has found.

In the trial to develop a new ADR checklist, care homes were able to identify unsuspected drug-related problems, often causing residents to be aggressive, and in pain. Triallist managers said the tool helped to boost their confidence to question and communicate with prescribers and reduce doses of antipsychotic medicines, reducing sedation and enabling residents to sleep better and feel brighter. 

The new ADRe Profile checklist, developed by Swansea University, identifies nine areas that may identify a drug-related health problem, including vital signs, observed problems, service user feedback, and tests performed in the past year. Answers are designed to help carers fix associated problems at an early stage.

Care home manager Sue Levey said: “It provides patient-centred care. It has made me reflect and think of things that I wouldn’t have [before]”.    

Swansea University has identified six scenarios in which care home residents should be monitored for an adverse reaction to their prescribed drugs:

  • A change of prescription: to provide a baseline so that the new medicine can be assessed shortly after and a few days later
  • Transition from one care setting to another: to check that all medicines are needed in the new setting
  • Pharmacist review: to provide additional background information
  • Scheduled consultant or GP appointments: to provide additional background information
  • Unscheduled care: to offer an overview of problems on a specified date
  • Unexpected clinical deterioration: to explore reasons.

Over half of care home residents are being prescribed medicines that they do not need, or which do not properly address their health problems, believes Swansea University professor of nursing Sue Jordan, who says that medicine-related side effects account for 5-8% of unplanned UK hospital admissions – most of which are preventable. 

Recent research by Healthwatch England reveals that readmissions to 70 English Trusts have risen by over a fifth in the past four years, to almost 485,000 – including avoidable readmissions.   

Professor Jordan told Care Home Management magazine: “People in care homes can be poorly, and it doesn’t take much to push them over.”

Completing an ADRe profile is said to take a nurse around 30 minutes. Read more on best practice in medicines management in care homes in the November issue of Care Home Management, online and posting now! 

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