This week NHS England responded to research that shows a worrying number of people with learning disability are being over prescribed medications. An urgent summit will be held today (17th July) to establish a plan of action to address it.
I have memories of long ago in the large institutions pushing around a trolley full of giant clanking bottles, pouring sticky pink and golden liquid into pots or counting hundreds of tiny pills into metal triangles to ensure the thirty plus people in my care were given their medicine. Anti-convulsants, anti-psychotics, sedatives, tranquilisers, drugs to counter the effects of other drugs – we doled out a huge number of potions in those days.
Prescribing in the big hospitals seemed to be a case of routine regimes followed in each case. There was a relatively small number of drugs in use and most people had a regime of similar doses of the same handful of medicines. Epliim and Phenytoin, Diazepam, phenobarbitone; we learned about the side effects, therapeutic doses and how to recognise them if they were found half-chewed down the side of the sofa.
Medical scrutiny
The one thing I remember from those days, however, was the routine checking of medication use by the hospital medical team. Everyone was subject to a regular review of how the medicine was working. Blood tests were taken for anti-convulsant levels and I learned to read and interpret lab reports. As a student, I was conversant with the therapeutic dose of most of the pills I doled out and could recognise and report any concerns over the effect of these as soon as I noticed them.
It would seem that we have lost something in the move away from this institutional model of care. Our routines were archaic and regimented, but with the advent of community care in small, less hospitalised services, we may have lost the benefit of medical scrutiny. We all know that GPs are phenomenally busy and that few are able to put in place management of medicine regimes for their patients. They are also very ‘G’. No offence chaps but the G stands for GENERAL …not specialist. Access to psychiatric consultants is difficult and referral can take months, so a family doctor will not necessarily put in place regular medication reviews as a matter of course.
Conflicting prescribing
Moreover, it is not in the gift of your GP to monitor closely the effects or side effects of the medicines your service users are taking. Unless they are made aware of changes and issues, they will blithely issue repeat prescriptions. It is really a job for those supporting vulnerable people to make a point of getting medications regularly reviewed. This is particularly relevant where a service user sees different hospital specialists. A consultant neurologist may prescribe a new drug without knowledge of the other medication the person is using. The GP cannot be gatekeeper over the contra-indications of medicines and the effects one may have on another, particularly with new and unusual drug choices.
So, in short, there is now an urgent action on the part of NHS England to review and respond to the news that for many people with learning disabilities their drug regimes are complicated, unchecked and potentially dangerously over-prescribed. In the meantime, it is for those supporting them to ask the questions “Is this really necessary?” and “When was this last reviewed?” of the pills and potions they administer.
Make sure your service users are being monitored and supported safely in their treatment plans. Check that the drugs do not conflict with one another, that the doses are not increasing without close checking and that they are still needed. Ask the questions.
Ginny Tyler – QCS Expert Learning Disabilities Contributor
