Zoplicone..falls..GP/NH rant

[love.dad.but..]

Dad has been on low dose of zoplicone for a long time to try and help him sleep at night, hasn't ever worked as in the 2.5 years in the NH even with slow mobility he is consistently up and walking 2 or 3 times during the night. As he declines he is now having regular falls at night in particular so I asked the NH to review zoplicone with GP as if even a low dose is contributing to risk of falls...7 in as many weeks nothing broken but head takes the brunt...and he is still up and about a lot at night then he isn't benefiting but zopliclone could be adding to the risk. So this was correctly recorded and a nurse duly spoke to a visiting GP. Another phone call today reporting another nighttime fall...more facial bruising...and on talking to the nurse GP had doubled the dose so today obviously they can hardly wake him up...increasing his risk of not only night falls but day as well. I don't know who I am more cross with...the nurse who isn't often on dads floor but should be aware of why he was being asked to speak to GP and importantly didn't question decision to double dose or the gp who clearly didn't understand the increased risk of doubling the dose and that was not what was being asked for. I have poa health the nurse who phoned knows dad well and said she was surprised the GP had made a bad fall risk worse and whilst they are not allowed to stop the prescription without GP approval I have told her night staff must not give him any tonight and I will take consequences as his attorney which she supports. I visit every other day and will go in tomorrow and discuss. I know falls cannot be prevented, dad would trip on a crash mat and he doesn't fall in the same place, he would climb over bed rails, they have put his bed against a wall and I have asked for a sensor mat which won't prevent falls but will alert staff quickly in the night but I won't accept his inevitable demise being brought about by incompetence and lack of common sense. Sorry feel upset and annoyed and will take it up with the manager in terms of a lack of double checking by the nurse that the the gp understood what was being asked for. What if this had happened to another resident on very crucial medicine.

 

[marionq]

Zopiclone can be very useful but it can as you say make falls more likely. I am surprised they kept giving it if it wasn't acting as a sleep aid.

 

[love.dad.but..]

I don't think the GP practice or NH are very proactive in meds reviews, all the changes have come about from my reviews and querying or asking for things to be looked at for dad. I guess as it hadn't been thought to cause any harm either up to when the night falls started the NH may have been hoping as dad declined they would have a positive effect. A little disappointed also with everything that is known about possible fall risk effects of z drugs that the lead came from me and not nursing staff. We held off giving it to him at home because the GP warned that as dad was so night mobile it could make matters worse and cause falls where previously none were happening. I am realistic about falls within this illness however.

 

[la lucia]

I think I have said this before but why is the GP dealing with this? It's better to call the Community Mental Health Team and ask for a visit. In most areas you can self-refer.

They are the experts when it comes to dementia and for some medications that may help in this situation only consultants can make the initial prescription.

The Zopiclone certainly sounds wrong and I think the CMHT are better placed to find a solution.

 

[oilovlam]

I'm not sure but don't people become immune (wrong word?!) to Zopiclone after a while and so it should only be used for short spells....otherwise you would have to keep ramping up the dose.

My doctor didn't want my mum to have any zopiclone because of the increased fall risk. He wanted 'old people's mental health' (OPMH) to make the decision to give zopiclone. In the end they didn't (I think they forgot during the OPMH review....the GP wasn't very specific in his referral) and when I got back to the GP he begrudgingly gave me 7 tablets (which thankfully broke mum's poor sleeping pattern). I did ask the GP during my first visit "What do they do in care homes when patients keep getting out of bed?". He said "They keep putting them back in bed". I was doing it +30 times a night and was even holding her in bed until she fell asleep (a very tiring time, very stressful). I thought at the time that the GP was talking rubbish and that they give sleeping tablets in care homes. You have just confirmed it.

BTW I told an OPMH nurse that the GP was reluctant to give zopiclone. She said that if he ever refused again she would have a word with him. So OPMH aren't against zopiclone. They realise that it has to be used....as much for the carer as the person with dementia. But if your dad is falling them perhaps there are better alternatives. My GP suggested warm milk....I think he was being serious.

That doesn't mean that Zopiclone is right for your dad.

I suspect that he shouldn't be on Zopiclone permanently. The GP may be trying a stronger dose for a short spell to try to 'break the pattern of sleeplessness'. But the GP should have communicated that to the care home....only give Zopiclone for a short spell, then stop. Also whilst on Zopiclone they should take extra precautions (alarm matt etc etc) and monitor him during the night.

The suggestion about OPMH is good. They are the experts....it sounds like the GP is out of his/her depth. The GP should have the best interests of your father in mind....it seems they are more concerned about making things easier for the care home.

You are also right in realising that there is no way to totally remove the risk of falls. But there are ways to reduce the risk. Presumably some sort of assessment of his living environment to remove trip hazards.

I hospital they put tables in front of patients (which are on wheels, easily pushed away). I said to the staff that they were using them as barriers....they looked at me aghast. "They aren't barriers" they say. But they are. The NHS also use alarm matts on bed/chair.....which is really just 'tick boxing' because they often got ignored.

Mum had a fall in hospital. I went in to see her unaware of the fall. She was left abandoned on a bed in the ward, naked from the waist down (she probably pushed off the blanket herself). The bed was at a steep angle, with no rails or foot/head board. I waited 10 minutes then went to find someone to complain (having made mum safe of course). I had a rant and was then told "Oh, by the way, your mum had a fall last night"....perfect!!

This just confirms to me that the NHS isn't a good environment. But nowhere is perfect. There's only so much you can do....but I think you are right to question the use of zopiclone.

 

[love.dad.but..]

Than you Oilavlam very useful information and sharing your experience. When I looked after dad in his home and he was awake at night pacing the GP gave a prescription for zopiclone but warned of the risk of falls where there wa s previously no risk so we decided against using at that time but to try and manage. Visiting today I have found out more information on why the GP probably made that decision...it would seem she wasn't told dad has had many recent falls and was told that I had said could it be reviewed as dad was awake at night! Totally not what I said and completely the opposite. So whilst I think the GP should have asked the nurse more questions about dad before doubling the dose, that should also have been queried by the nurse...different one who I spoke to at monthly review. I agree whilst I hadn't thought it was of benefit to dad in the past as he was still up in the night equally someone should have perhaps thought is it wise for him to still be on it. 2 nurses today support me fully and see this as a serious lapse, they are not giving zopiclone to dad again tonight or tomorrow...thank goodness I have poa health which has allowed me to make this decision...and dad is on the GP list for Tues so I can discuss this fully. I will be speaking to the manager about the many issues this matter has raised for me

 

[Linbrusco]

While I still can't be 100% sure that no residents at Mums care home are on any sleeping meds, when speaking to management I was told that they did not give sleep meds due to fall risks. If they did have to give anything it was melatonin.
That beds were lowered to floor, with fall mats if they were at fall risk.
If a resident got up at night, they tried 3 times to take them back to bed. If unsuccesful they would let them stay up in the lounge, give them a warm drink, something to eat and try again later.
One gentleman there does not sleep for 48 hrs straight, and then sleeps for 24,hrs on the third day.

Very bad communication between your Dads GP and nusting staff, with potential serious consequences I feel.

 

[oilovlam]

Presumably as 'Health & wellbeing' POA the GP should keep you in the loop about any decisions made.

Miscommunication that could have been serious, as you say. There must be a better way to do this, rather than rely on Chinese whispers. I bet the GP will be annoyed that they weren't given the correct information (your thoughts and also the recent falls). But they should have known better...I think the increased risk of fall is widely known.

Best of luck anyway.

 

[Bod]

Dad has been on low dose of zoplicone for a long time to try and help him sleep at night, hasn't ever worked as in the 2.5 years in the NH even with slow mobility he is consistently up and walking 2 or 3 times during the night. As he declines he is now having regular falls at night in particular so I asked the NH to review zoplicone with GP as if even a low dose is contributing to risk of falls...7 in as many weeks nothing broken but head takes the brunt...and he is still up and about a lot at night then he isn't benefiting but zopliclone could be adding to the risk. So this was correctly recorded and a nurse duly spoke to a visiting GP. Another phone call today reporting another nighttime fall...more facial bruising...and on talking to the nurse GP had doubled the dose so today obviously they can hardly wake him up...increasing his risk of not only night falls but day as well. I don't know who I am more cross with...the nurse who isn't often on dads floor but should be aware of why he was being asked to speak to GP and importantly didn't question decision to double dose or the gp who clearly didn't understand the increased risk of doubling the dose and that was not what was being asked for. I have poa health the nurse who phoned knows dad well and said she was surprised the GP had made a bad fall risk worse and whilst they are not allowed to stop the prescription without GP approval I have told her night staff must not give him any tonight and I will take consequences as his attorney which she supports. I visit every other day and will go in tomorrow and discuss. I know falls cannot be prevented, dad would trip on a crash mat and he doesn't fall in the same place, he would climb over bed rails, they have put his bed against a wall and I have asked for a sensor mat which won't prevent falls but will alert staff quickly in the night but I won't accept his inevitable demise being brought about by incompetence and lack of common sense. Sorry feel upset and annoyed and will take it up with the manager in terms of a lack of double checking by the nurse that the the gp understood what was being asked for. What if this had happened to another resident on very crucial medicine.

Oh Boy!!
Does this sound familar.
Zoplicone....work of the devil!!
FiL was on this, doing exactly the same, not sleeping, wandering, falling.
Unless on a much higher dose, then couldn't wake up, and in danger of heart failure(in his case).
Zoplicone is a short term medication 7-10 days only. Read the instructions, to the GP if nessary.
Zoplicone when used for any longer will cause these problems.
He must be taken off this, there is nothing else that will help, your father will be slightly worse for a short while, but will then settle down.
In our case, it was finding out, why he was wandering at night, hunger, toast & marmalade in bed, at 10pm was our cure!
You will need(Care Home will need) to find out if he needs anything in the night, it might be hunger, loneliness, thirst, hot/cold. Find this need, fix it. Peace will happen.

Bod