Downloading PDF

Reducing the use of Lorazepam at a dementia nursing care home

Reducing the use of Lorazepam at a dementia nursing care home

Home » Case studies » Reducing the use of Lorazepam at a dementia nursing care home

Our Medicine Optimisation Care Home team successfully reduced the reliance on regular Lorazepam prescriptions in elderly residents of a dementia nursing care home, improving medication safety and appropriateness through comprehensive structured medication reviews and a multidisciplinary approach.

Background

A GP practice in Preston observed a concerning trend at a local dementia nursing care home. There was a notable increase in the number of Lorazepam prescriptions, alongside requests to shift from ‘when required’ to ‘regular’ dosing for its residents. Lorazepam, typically prescribed for short-term management of anxiety or insomnia with anxiety, is known for side effects such as drowsiness, loss of coordination, dizziness, and a heightened risk of falls, especially in the elderly. The primary goal was to ensure that the prescription of Lorazepam was clinically appropriate for each resident. This involved a collaborative effort with the care home’s carers, the GP, and the specialist mental health team, forming a multidisciplinary approach to optimise patient outcomes.

Action

NHS Midlands and Lancashire’s Medicine Optimisation Care Home (MOCH) team initiated a series of structured medication reviews (SMRs) for residents on Lorazepam, assessing the appropriateness of its prescription. The care home was guided to enhance care plans, detailing each resident’s typical and atypical behaviours. These plans were to include explicit guidelines on alternative techniques to be attempted before the administration of Lorazepam. During weekly ward rounds, the MOCH pharmacist, accompanied by an advanced nurse practitioner from the GP practice, reviewed positive behaviour plans and evaluated the judicious use of Lorazepam. Recommendations based on these evaluations were discussed and implemented as needed.

Impact

Over three months, the MOCH team conducted 12 structured medication reviews for residents prescribed Lorazepam, with a notable majority (83%) of these patients aged 75 or older. The initiative led to a total of 54 interventions categorised by their impact on patient safety and care quality:

– Low impact interventions (7 instances): These interventions included examples such as modifying paracetamol prescriptions to variable repeats and reducing the quantity of sodium feredetate from 500ml to 300ml for a 28-day supply.

– Medium impact interventions (38 instances): Actions taken included dose adjustments for antidepressants due to adverse ‘hang-over’ side effects, mental health referrals, and discontinuation of no longer needed medications like Lactulose, presenting a moderate risk to patient safety.

– High impact interventions (7 instances): These interventions had the potential to significantly impact patient safety, including the cessation of Lorazepam in a resident with Alzheimer’s disease, indicating a direct approach to minimising harm.

The team’s efforts resulted in 27 instances of cost savings, amounting to £7,137 annually. Additionally, 25 medicines were discontinued, contributing to a more streamlined and safer medication regimen for the residents.

Specific outcomes related to lorazepam included:

– Lorazepam was discontinued for 6 residents.

– For 2 residents, Lorazepam was adjusted from ‘regular’ to ‘when required’ doses.

– 3 residents experienced dose reductions.

– 1 resident’s Lorazepam treatment was deemed still appropriate after review.

For residents where lorazepam was discontinued, tailored positive behaviour plans were developed. These plans emphasised distraction techniques such as discussing family and organising activities such as singing and drawing to manage behaviours without medication.

The work of the MOCH team enhanced ongoing communication between the GP practice and the nursing care home, resulting in a collaborative environment for continuous improvement in patient care. Following the latest Care Quality Commission inspection, the care home received positive feedback for its approach to medication safety, specifically regarding the reduced use of ‘as and when required’ medicines. This multi-faceted approach underscores the significant strides taken to ensure the well-being and safety of residents through meticulous medication management and the promotion of non-pharmacological interventions.

Feedback

‘Working alongside Tanveela on medication reviews was a pleasure, undertaking 12 structured medication reviews for patients prescribed Lorazepam. The outcome was beneficial for the patients and a great learning curve for me, working alongside with someone with the experience to guide me to make switches for the benefit of the patients. The review highlighted the need to be aware of medication effects and the side effects for patients, the impact of not over-sedating, prevention of falls, and the prevention of admissions. Discussing positive behaviour plans also impacts greatly on the patient’s daily living and being able to manage escalations of mood. The interventions proved very successful. Anne-Marie Potter | Advanced Nurse Practitioner

For more information

For more information and to learn how we can help your organisation, please contact us.

View all

News and views

News

Our commitment to ethical sourcing and supplier management

Our Procurement teams – healthcare and goods and services – have once again achieved the Chartered Institute of Procurement and Supply (CIPS) Corporate Ethics…

News

NHS Midlands and Lancashire shortlisted for the 2024 Patient Experience Network National Awards

We are delighted to announce that NHS Midlands and Lancashire (NHS ML) Nursing and Urgent Care Team has…

News

Join our inaugural ‘SU Insights’ session: Contracting for health outcomes

Join us for the inaugural session of our new event series, ‘SU Insights’, where we’ll explore the evolving…

View all

How we can help health systems

Business enabling services

Delivering a wide range of support functions through transactional services, business partnering and transformation that drives efficiencies and releases value and time…

Learn more about Business enabling services
Business enabling services

Clinical redesign and provider collaboration

Redesigning how health and care works across England - placing people at the centre of their own health and care and utilising…

Learn more about Clinical redesign and provider collaboration
Clinical redesign and provider collaboration

Communications and engagement

Supporting ICSs with approaches to design and deliver effective communication, engagement and behavioural insights as a key enabler for system change and…

Learn more about Communications and engagement
Communications and engagement

Developing health systems

Acting as an independent and trusted partner within the system to facilitate working across stakeholders and integrate elements of the provider system…

Learn more about Developing health systems
Developing health systems

Digitally enabled transformation and IT

Digitising care and partnering with systems for the transformation of digitally enabled service delivery (and other supporting processes) across vision, planning and…

Learn more about Digitally enabled transformation and IT
Digitally enabled transformation and IT

People solutions

Supporting systems to build a sustainable and integrated workforce, transforming systems, organisations and the workforce experience to improve resilience.

Learn more about People solutions
People solutions

Personalised healthcare commissioning services

Providing end-to-end funded care services, including patients as active partners in identifying their healthcare needs and then commissioning care to meet these.…

Learn more about Personalised healthcare commissioning services
Personalised healthcare commissioning services

PHM analytics and decision support

Applying intelligence-led understanding of the health of the population to support the redesign of care and improve patient and financial outcomes across…

Learn more about PHM analytics and decision support
PHM analytics and decision support

Place and primary care transformation

Supporting providers to work together at a place and neighbourhood level to manage common resources, integrate community teams, improve health and reduce…

Learn more about Place and primary care transformation
Place and primary care transformation
MLCSU