A study on antipsychotic medication prescription in elderly patients in Royal Gwent Hospital.

Introduction -The use of anti-psychotics is higher in older people than their younger adult counterparts due to high prevalence of dementia/delirium. Anti-psychotic drugs cause side effects which include cardio vascular, metabolic, extra pyramidal and high risk of falls. So, we set out to do a QIP on antipsychotic medication prescription on our Geriatric wards and compared it with NICE guidelines.

Method- We had 2 approaches to use. Firstly, we prepared a check list for anti-psychotic medication monitoring according to NICE guidelines 2021 and we applied this retrospectively to 17 patients who had been initiated on anti-psychotics within last 12 months, the aim being to compare our practice with best practice. Secondly, we prepared a questionnaire for doctors to assess their knowledge about antipsychotic NICE guidelines and we distributed it to 14 junior doctors in RGH.

Results- • Main Indication for prescribing antipsychotics was Behavioural and psychological symptoms of dementia (BPSD) - 94% of the time • Risperidone was the most commonly prescribed (64%) antipsychotic for our patients • 83% of them had non pharmacological methods tried before considering antipsychotic medications. • 82% had their baseline ECGs checked • 35% had their lipids checked and 47% had their HbA1c checked • 52% of the doctors were aware about NICE guidelines on prescribing anti-psychotic medications • 70% of the doctors had knowledge about the side effects.

Conclusions- Our study showed the most commonly used antipsychotic drug was risperidone. We were good at documenting the indication, trying non pharmacological methods and discussing side effects with patients/family. Hba1c, lipids and prolactin were not often checked, showing room to develop best practice. We therefore are in the process of finalising a sticker so that we can follow the guidance set by NICE for prescription of antipsychotics. To improve knowledge of antipsychotics in doctors, we have presented the findings and aim to put up posters on all medical wards and to teach at our local level during doctor change overs