Appropriate prescribing of anti-psychotic medication for non-cognitive symptoms in people with dementia

Introduction
Dementia is marked by progressive cognitive decline and frequent neuropsychiatric symptoms, which heavily impact patients and caregivers. Antipsychotic use in dementia requires careful risk-benefit analysis due to risks like sedation, falls, extrapyramidal side effects, and increased cerebrovascular events. Recent studies show a threefold rise in stroke risk with certain antipsychotics.

Methods
A retrospective review of dementia patients prescribed antipsychotics for non-cognitive symptoms assessed documentation quality. Key points included comprehensive assessments, trials of non-pharmacological interventions, indications for antipsychotics, discussions with patients/caregivers on risks and benefits, side effect monitoring, and avoidance of benzodiazepines.

Results
Cycle 1 (31 patients): Comprehensive assessments were done for all, and non-pharmacological interventions documented in 90%. Common indications were psychosis (68%) and agitation (55%). Discussions occurred in 61%, but only 13% documented explicit risk communication. Risperidone was the most used antipsychotic (65%). Follow-ups and side effect monitoring were routine; benzodiazepines were avoided in 94%. No antipsychotic prescribing sticker was used.

Cycle 2 (32 patients): After introducing a prescribing sticker and education, non-pharmacological interventions rose to 97%, discussions to 81%, and risk communication to 84%. Risperidone remained common (53%). Follow-up planning and monitoring stayed high, with benzodiazepine avoidance at 94%. The sticker was used in 16% of cases.

Conclusion
The audit demonstrated improved antipsychotic prescribing in dementia, with better documentation, risk communication, and adherence to non-drug strategies after educational interventions. Practices became safer, more patient-centered, and aligned with guidelines.