Medication review issues

[Helly68]

Recently my father and I attended a multidisciplinary team meeting at my mother's care home - with reps from the home and medical team.

During the meeting we reviewed her medication and found that somehow she is receiving a higher dose of a mood stabiliser - carbamazepine than was originally prescribed. At the meeting it wasn't clear if this was an error or that the GP (who wasn't there) had legitimately upped the dose because of agitation.

Mummy has also had a lot of falls which were the main reason for the meeting.

We asked for the dose of the mood stabiliser to be confirmed, so that we understood what had happened and if she is getting the right dose.
I also wondered if this medication (along with many others she takes) could contribute to falls - e.g. drowsiness, clumsiness. We were told not.

Since the meeting we have had a phone call about the mood stabiliser to say that it wasn't a medication error, rather a "communication error" (I think the difference here might be semantic) and that they didn't think they should change to dose to what was originally prescribed as "it (the drug) wouldn't affect her falls".

Anyone here have experience of medication errors and or medication and falls?

I still think that if she isn't getting the dose that was originally prescribed, why not? I think the fall thing, though it may be related is a bit of a red herring here. Are they covering their backs?

I am thinking of asking to speak to the older age doctor as to the rationale behind their decision and to ask whether she could go back to the original dose. However, I am concerned if we lower the dose, will she become agitated?
I have medical POA and DOLS authorisation. Feel there isn't much point trying to be in a guardian role if I am not clear about the rationale for decisions like this?
Maybe I should leave it to the professionals? Anyone else had anything like this?

 

[DeMartin]

Recently my father and I attended a multidisciplinary team meeting at my mother's care home - with reps from the home and medical team.

During the meeting we reviewed her medication and found that somehow she is receiving a higher dose of a mood stabiliser - carbamazepine than was originally prescribed. At the meeting it wasn't clear if this was an error or that the GP (who wasn't there) had legitimately upped the dose because of agitation.

Mummy has also had a lot of falls which were the main reason for the meeting.

We asked for the dose of the mood stabiliser to be confirmed, so that we understood what had happened and if she is getting the right dose.
I also wondered if this medication (along with many others she takes) could contribute to falls - e.g. drowsiness, clumsiness. We were told not.

Since the meeting we have had a phone call about the mood stabiliser to say that it wasn't a medication error, rather a "communication error" (I think the difference here might be semantic) and that they didn't think they should change to dose to what was originally prescribed as "it (the drug) wouldn't affect her falls".

Anyone here have experience of medication errors and or medication and falls?

I still think that if she isn't getting the dose that was originally prescribed, why not? I think the fall thing, though it may be related is a bit of a red herring here. Are they covering their backs?

I am thinking of asking to speak to the older age doctor as to the rationale behind their decision and to ask whether she could go back to the original dose. However, I am concerned if we lower the dose, will she become agitated?
I have medical POA and DOLS authorisation. Feel there isn't much point trying to be in a guardian role if I am not clear about the rationale for decisions like this?
Maybe I should leave it to the professionals? Anyone else had anything like this?

It’s worth googling carbamazepine, there is a NICE article on it and dementia.

 

[Helly68]

It’s worth googling carbamazepine, there is a NICE article on it and dementia.

Thank you - will do this.

 

[2jays]

There is a thread on here about what over prescribing has caused a family member and the major mental and physical distress this has caused them

IN MY OPINION
It’s a case of one hand not doing their job properly and another just playing with different tablets without thinking of the consequences of mixing these drugs and dementia.

It’s a lot to ask.... on top of your other worries, but keep a close eye on medication changes if you can

 

[Bod]

Is she on any form of sleeping medication?

Bod

 

[Helly68]

There is a thread on here about what over prescribing has caused a family member and the major mental and physical distress this has caused them

IN MY OPINION
It’s a case of one hand not doing their job properly and another just playing with different tablets without thinking of the consequences of mixing these drugs and dementia.

It’s a lot to ask.... on top of your other worries, but keep a close eye on medication changes if you can

Thank you for that comment. I had also suspected a bit of back-covering going on. I will keep an eye

 

[Helly68]

Bod, No, I don't think sse is. She is sleeping fine at the moment though does seem to me (though not the care home staff) very tired during the day.

 

[Helly68]

Thank you for that comment. I had also suspected a bit of back-covering going on. I will keep an eye

Also - 2jays I should have said, very sorry that your family member had to go through this

 

[2jays]

Also - 2jays I should have said, very sorry that your family member had to go through this

Thankfully it was not my family member, though there were “minor” issues with my mums medical care.

xxxx

 

[Canadian Joanne]

I looked it up and it's primarily an anticonvulsant, used for epilepsy. If it's being used as a mood stabiliser, that would be an off-label use.

Question - can the PoA in the UK override the doctor? I know I could (and did, in a couple of cases) but it seems that isn't the case in the UK>

 

[Helly68]

I looked it up and it's primarily an anticonvulsant, used for epilepsy. If it's being used as a mood stabiliser, that would be an off-label use.

Question - can the PoA in the UK override the doctor? I know I could (and did, in a couple of cases) but it seems that isn't the case in the UK>

Thanks Joanne. It isn't so much that I want to override it, but I would like to understand why, having established that somehow she is being given a higher dose than originally intended, we are now not reducing the dose - or at least that appears to be the clinical view.
I think they would reduce it, if we asked for this (as in me and my father) but I don't want to pursue this to prove a point and risk her having a return to agitation.
I think I will ask to talk to the doctor, at least to understand the reasoning....

 

[Bod]

Bod, No, I don't think sse is. She is sleeping fine at the moment though does seem to me (though not the care home staff) very tired during the day.

Do any of her medications, have a side effect of drowsiness?
This could be caused by a combination of different pills, which will best be answered by a friendly pharmacist, rather than Google.
FiL had falls caused by sleeping type meds. Made him so tired he couldn't stand, but didn't understand he should go to sleep! Getting him off them, falls stopped, and sleeping started.

Bod

 

[Helly68]

Thanks everyone for your helpful responses. I have decided to ask the home for a phone call with the geriatrician, so I can understand the rationale behind keeping her on the higher dose. Once I know this I may ask to see if the dose could be reduced if they feel this is safe. Communication - too many agencies, multiple drugs and decision makers make this harder than it should be....

 

[Helly68]

Do any of her medications, have a side effect of drowsiness?
This could be caused by a combination of different pills, which will best be answered by a friendly pharmacist, rather than Google.
FiL had falls caused by sleeping type meds. Made him so tired he couldn't stand, but didn't understand he should go to sleep! Getting him off them, falls stopped, and sleeping started.

Bod

Bod - this is a disputed point atm. I think that some of her meds could and do cause drowsiness but the home staff say not. I have to say that they see her more than me so want to take their view on board. I think I need to clarify the decision to keep her on the higher dose first, so at least I can try to understand that. I think sadly there is some professional back-covering going on here, not by the care home staff whove been great.

 

[love.dad.but..]

Dad was a night time walker and pacer...while he was being looked after by me in his home GP was reluctant to prescribe zopliclone for sleeping as he was finding his way round the house and at that stage not at risks of falls so whilst he and I were sleep deprived it was a balance which I accepted. Fast forward to his NH..unbeknown to me...I had health poa for dad...zopliclone low dose was prescribed. It made no difference to him...he still got up and paced at night. However...as he declined he had quite regular bad falls injuring his face often and required hospital treatment. I had researched that zopliclone could increase the risk of falls with a pwd especially one who was already high risk as dad was by then. Following yet another early hours fall and bruising I asked that no more be given from that night and would speak to the GP. This was agreed but the nurse in question relayed the message to a visiting GP before I could see him that my dad wasn't sleeping so the GP doubled the dose for that night! Dad then had a nasty mid night fall the same night he had the doubled dose. It may have happened anyway but I don't think it was a coincidence and so was furious. I met with the GP the next day and she apologised ...the drug should only be a short term pattern change fix ie 6 weeks..Dad had been on it as far as I could see 6 months and this should have been picked up by the GP..she agreed it increased his risk greatly and had she been told about his fall the previous night and history of at least 2 falls a week for months...the bruised face should have been a clue!...she would have questioned the nurse further about being asked to review dose which she assumed meant increasing. So...very poor written and verbal communication which resulted in a serious safeguarding concern and the nurse given extra training. It could have been a lot worse for dad but it was so uneccessary and I reminded the usually good NH that as dad's health attorney I should always be consulted if they request which I think probably happened in the first instance sleeping tablets etc.

I had full support from the NH GP on this and other med reviews for dad but I think best interests decision by medics override an attorney's wishes if deemed better for the pwd however any decision has to be fully explained and justified to the attorney.

 

[Bod]

Bod - this is a disputed point atm. I think that some of her meds could and do cause drowsiness but the home staff say not. I have to say that they see her more than me so want to take their view on board. I think I need to clarify the decision to keep her on the higher dose first, so at least I can try to understand that. I think sadly there is some professional back-covering going on here, not by the care home staff whove been great.

Helen, I really feel this is something, where you should do the homework, then you are in a position to judge the accuracy of what you are being told.
Bear in mind, with some staff, provided they are not disturbed, then all is well.

Bod

 

[Helly68]

Helen, I really feel this is something, where you should do the homework, then you are in a position to judge the accuracy of what you are being told.
Bear in mind, with some staff, provided they are not disturbed, then all is well.

Bod

Thanks Bod. I have been asking colleagues (I work in the NHS but am not clinical) and have been looking at the NICE guidance, as advised above. It is a tricky situation though, but I welcome your comments and will do a bit more digging...

 

[Helly68]

Dad was a night time walker and pacer...while he was being looked after by me in his home GP was reluctant to prescribe zopliclone for sleeping as he was finding his way round the house and at that stage not at risks of falls so whilst he and I were sleep deprived it was a balance which I accepted. Fast forward to his NH..unbeknown to me...I had health poa for dad...zopliclone low dose was prescribed. It made no difference to him...he still got up and paced at night. However...as he declined he had quite regular bad falls injuring his face often and required hospital treatment. I had researched that zopliclone could increase the risk of falls with a pwd especially one who was already high risk as dad was by then. Following yet another early hours fall and bruising I asked that no more be given from that night and would speak to the GP. This was agreed but the nurse in question relayed the message to a visiting GP before I could see him that my dad wasn't sleeping so the GP doubled the dose for that night! Dad then had a nasty mid night fall the same night he had the doubled dose. It may have happened anyway but I don't think it was a coincidence and so was furious. I met with the GP the next day and she apologised ...the drug should only be a short term pattern change fix ie 6 weeks..Dad had been on it as far as I could see 6 months and this should have been picked up by the GP..she agreed it increased his risk greatly and had she been told about his fall the previous night and history of at least 2 falls a week for months...the bruised face should have been a clue!...she would have questioned the nurse further about being asked to review dose which she assumed meant increasing. So...very poor written and verbal communication which resulted in a serious safeguarding concern and the nurse given extra training. It could have been a lot worse for dad but it was so uneccessary and I reminded the usually good NH that as dad's health attorney I should always be consulted if they request which I think probably happened in the first instance sleeping tablets etc.

I had full support from the NH GP on this and other med reviews for dad but I think best interests decision by medics override an attorney's wishes if deemed better for the pwd however any decision has to be fully explained and justified to the attorney.

Sorry to hear that you had to go through this. I am afraid that these things happen, even though they shouldn't. I will keep on researching the drugs involved to try and get to the bottom of this. Thanks for your input

 

[Bod]

Thanks Bod. I have been asking colleagues (I work in the NHS but am not clinical) and have been looking at the NICE guidance, as advised above. It is a tricky situation though, but I welcome your comments and will do a bit more digging...

Go down to the pharmacy with a packet of chocolate biscuits, all will be revealed, in a shower of crumbs!

Bod

 

[Helly68]

Go down to the pharmacy with a packet of chocolate biscuits, all will be revealed, in a shower of crumbs!

Bod

That's a good idea.....