College of Physicians should investigate seniors’ antipsychotics prescriptions
The news that one in four seniors living in B.C. long term care facilities are being given antipsychotic medication without a supporting diagnosis is appalling. A report from the BC Care Providers Association notes that “although originally developed to treat schizophrenia and bipolar disorder, antipsychotics are now commonly prescribed to treat behavioural and psychological symptoms associated with dementia. Research shows the drugs provide limited benefit and cause serious harm, increasing the risk of falls, infections, stroke and even premature death.”
Like you I suspect that these drugs are being given to care home residents as a form of chemical restraint.
But let us not lose sight of the fact that these drugs can only be obtained through a prescription written by a physician.
So, we need to question whether the prescribing doctors are following the guidelines of the College of Physicians and Surgeons of British Columbia concerning prescribing practices. These guidelines say in part:
“The provision of a prescription to a patient is a medical act. It is the result of a clinical decision made by a physician subsequent to a comprehensive evaluation of the patient by that same physician. This evaluation should be based on a face-to-face encounter with the patient which includes the usual elements of clinical assessment such as the taking of a history, conducting a physical examination and any necessary investigations, and reaching a provisional diagnosis. Patient records should clearly reflect that the pertinent elements of the patient evaluation have been completed and documented.
“If a medication is prescribed, physicians have a responsibility to advise the patient about such matters as drug effects and interactions, side effects, contraindications, precautions, and any other information pertinent to their use of the medication. There is an obligation for the prescribing physician to arrange appropriate follow-up, either personally or with the most responsible physician.”
It seems to me that it is not unreasonable, given the BC Care Providers Association report, to call on the College of Physicians and Surgeons of British Columbia to investigate the extent that its members practising at long term care facilities are following the prescribing guidelines. If they find that the guidelines are not being followed they should take appropriate disciplinary action. At the same time they should question whether the care home procedures are strict enough that, even if these drugs are necessary in the interests of specific patients, the drugs are administered only by authorised staff at the correct dosage and only to the individuals for whom they have been prescribed.
As a society we have a responsibility to advocate for seniors’ safety and well-being in long-term care and must ensure abuse with drugs is not part of the equation.