Abstract
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.