Feb 06, 2018

Underdosing Pain Medications and Overdosing Antipsychotic Drugs

Getting medication right is a delicate thing when you or a loved one is in care, and medication errors pose one of the greatest risks to patient safety.

Giving too little medication will not be effective and will  leave the patient or resident in a great deal of discomfort.

Giving too much and there can be dire and side effects – which can include death.

Pain, Pills and Palliative Care

According to new research, this is especially an issue in palliative care. In a reviewed paper published in ‘British Medical Journal (BMJ) Supportive and Palliative Care, it was found that errors involving pain relief medication are almost three times higher than previously reported.

More than half of the errors, approximately 57 per cent, involved patients receiving a lower dose of pain relief than ordered, requiring clinical intervention in a third of cases.

The majority of patients were in their 70s and were in palliative care because of cancer.

Of errors that were identified, most involved morphine doses while two-thirds were related to administration errors.

Researchers say that understanding how these errors come about is important, as it should be a priority to decrease mistakes in a clinical setting.

The most commonly used pain medication used in palliative care are opioids, which are considered high-risk medicines.

The risk is amplified in people who are older, have multiple health issues and are taking numerous medications.

Dosage of Drugs for Dementia

In comparison to pain medications being under-dosed in palliative setting, there are concerns that some antipsychotics are being over-prescribed to older people with dementia.

According to numbers from Dementia Australia, up to 70,000 are taking antipsychotic medications. But of that group, only one in five receive any real benefit from their prescribed dosage.

“I was bothered by the way we care for people living with dementia in particular the use of antipsychotics” Dr Power, certified geriatrician, told HelloCare.

Dr Power says that he saw a large use of antipsychotics and it was something he always resisted.

“I’ve used a lot fewer drugs than my colleagues, even way back when there wasn’t any evidence against them, because I didn’t like the way they affected people”

Though Dr Power could see that people were “quieter” he didn’t really believe that they were “happier” or “more relaxed” or “more engaged”, rather they were more sedated.

The mistake often made with people with dementia is that their symptoms are something that needs to be medicated – when in reality symptoms such as agitation, restlessness and aggression are really unmet needs.

Before medications are prescribed, other alternative therapies should be utilised first and only if those do not work should antipsychotics be prescribed.

According to Dementia Australia, some studies have suggested that antipsychotic use may be associated with faster cognitive decline in people with dementia, but this finding is controversial and not supported by some other research.

What may occur is that mental function is slowed in people with dementia who take antipsychotics so that they appear to have deteriorated, though this deterioration may be reversible if the drug is ceased.

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