Managing resident prescriptions
pain
ADVERSE EFFECTS
Independent prescribing activity was a key role of PIPs in the multidisciplinary team. Their involvement could directly benefit residents, often because this could progress a new prescription much more speedily:If my residents are feeling their symptoms, then refer to the PIP, and the PIP will prescribe immediately, there will immediate response, and then the residents will be happy CH manager_21b.Other CH teams identified how having direct contact with a PIP stopped conditions worsening, ‘Key to successful deprescribing, reducing or stopping a medicine, was the PIP having trustful relationships with the CH team, the GP and the resident or their family. The importance of this trustful relationship was made evident when CH teams explained how they were now confident in trying to titrate prescriptions down as they knew the PIP was easy to contact and had agreed that if there were adverse effects the process could be stopped, and the medicine reinstated:Seeing PIP on a weekly basis meant we were able to make some huge reductions but also we were both very honest with each other so when we had got rid of almost everything and then resident’s behaviour got worse again, we were able to add in a tiny little bit of something and I mean tiny bit which was appropriate CH Manager_9.Titrating antipsychotic medicine is a complex process and each stakeholder needs to be fully committed and in good communication with each other. Here, a PIP explains how the process continued after the intervention ended, illustrating the continued benefit of having PIPs working in the GP practice:We had started to titrate it down and for a few days they were okay and then they started to need a lot of diazepam so we increased it back up but now it has come back down by half; they are checking and watching even though the study has ended because I have been involved and generally keeping an eye on things too they still have my contacts. PIP_1.Discussions on deprescribing were also enabled between PIPs and the resident or their relative, thereby providing more patient-centred care. A CH manager explains:…talking through that with the PIP and the resident she has come full circle and is off her Butec patches with no pain; that was agreed with her and her family … she didn’t mind coming off and giving it a trial period CH Manager_6.