Wednesday, 24 November 2010

Care Homes and Drug Errors

Okay, I admit it, when it comes to adverse reporting on care homes - I am definitely hypersensitive, defensive and probably many more ' 'ives' than I can bring to mind at this moment in time.

I know that in the big bad world out there, there are indeed, many bad care homes - as, as is, dire care in hospital settings (I acknowledge some of the reasons - dangerous staffing levels, etc), but nevertheless, bad care exists there too.  There are uncaring doctors both in hospitals and GP practices.  But, whatever the wrongs outside care homes - it doesn't make bad care in care homes right!

The reason for this post - stuff I read in Pulse today.  It was "Call to reduce 'counter-productive' cardiovascular drug prescribing in the over-80s"  Video to watch at the bottom of this (Pulse) page too.  I have no problem with this and have also considered the chemical cocktails that the elderly receive.  I know I am not a doctor and therefore readily admit, I don't know what the hell I am talking about!  However, it appears to me, that even though drug A does not interact with drug B, or drug F does not interact with drug H (or even if it does - Flossy needs both of them anyway) - does a combination of A, D and E unknowingly interact with drug G?

Is polypharmacy a GP and/or hospital doc initiated (possibly fatal in the elderly - or anyone?) chemical cosh, that falls outside the care home initiated (in your dreams) chemical cosh of antipsychotics?

Nevertheless, I digress!  A bullet point in the aforementioned "Call to...." in 'Problems with care home prescribing' was "On any one day 7 out of 10 patients experienced at least one medication error" - Ooh, dear me(!), this sent the defensive hackles into overdrive!  I am not brilliant at stats, but easily worked out, that on an average day/night; I routinely gave (on my shift), 30% of my lovely residents, the wrong meds!  Am I thick!?  Would I not know?

Yes, on one (known) occasion, I did give a resident somebody else's meds (distracted by World War Three, for care home residents are not continually semi-comatose by home inspired antipsychotics!) - but I instinctively knew that I had!  I immediately consulted the BNF - thought "Oh My God" (possible bad drug interactions) and contacted the local A & E - for I would rather lose my job, than have somebodies death on my hands.  Given instructions on observations and luckily, everything was tickety-boo!

I have digressed again!  Further research at NHS Choices gave a wider view!  I am relieved!  It is not only care home staff, but pharmacists, GPs et al that produce the 7 out of 10 figures.  But will the general public see this?  No - they will not!  They will just see that care homes are dangerous places (and 'Yes', some of them are) and they will be so afraid.

I do remember Copperfield writing a post on this issue, earlier this year - but I cannot find it.  Yet again, Copperfield's understanding of this situation earned my respect.  I don't care that, at times, Copperfield  alludes to 'granny'stackers' for he/she/they are in touch with the real world.

In my experience, many GPs enter homes with a negative view - and the vicious circle continues - mistrust abounds.  The patient  (or residents)  interests are paramount - and we must remember this  For if not, we are doing the most vulnerable a great disservice.

Anna :o]

No comments: