Medication Review
A bit of catching up to do.
Rosemarie was transferred to Croydon Community Mental Health Team when she was discharged to the Care Home. The assigned nurse has been very supportive and in our last conversation before Christmas I raised the issue of Rosemarie's medication. The basic prescription (Sertraline, Donepezil, Allopurinol) predates her admission to hospital, where they added Clonazepam to control the jerking. Zopiclone was added by the doctor at the Care Home to help her sleep. Quite a cocktail, and I thought it was time for a review. The jerking seemed to be getting worse, the standing up / sitting down was getting almost manic, and she was regularly upset.
I don't want to disparage her GP, whom I have never met, but then neither has Rosemarie as far as I know. The Care Home has too many residents to be catered for by a single GP practice, so care responsibility is distributed as available and with no particular regard to the speciality of the GP. There is an alarming tendency for GPs (and any other professional) to get stuck in time at the point they finished their training, and I was very glad to find out that - at least for the next few months - a specialist doctor was available from the Community Mental Health Team would be available.
We met at the Care Home on 30th December. Very interesting. The original prescription for Donepezil had specified it should be taken in the morning. The doctor was surprised at this, since apparently it has a tranquilising effect initially then a stimulating effect some twelve hours later. It should be taken in the evening. There was also some evidence that it could be responsible for agitation and depression. He recommended that we start to reduce the dosage in a methodical way and see what effect it had on her behaviour, and then move on to looking at the Sertraline, which could also be contributing to the problems.
He seemed a very intelligent, sensible person and my daughter and I left the meeting generally satisfied and relieved. The only cloud on the horizon was that it was unlikely this level of support would last.
As part of the continuing break-up of the NHS, the responsibility for Mental Health Care for all Care Home residents has to be transferred to the care of the assigned GP by some date in the spring.
Her care will then be in the hands of someone with no specialist knowledge at all.
Rosemarie was transferred to Croydon Community Mental Health Team when she was discharged to the Care Home. The assigned nurse has been very supportive and in our last conversation before Christmas I raised the issue of Rosemarie's medication. The basic prescription (Sertraline, Donepezil, Allopurinol) predates her admission to hospital, where they added Clonazepam to control the jerking. Zopiclone was added by the doctor at the Care Home to help her sleep. Quite a cocktail, and I thought it was time for a review. The jerking seemed to be getting worse, the standing up / sitting down was getting almost manic, and she was regularly upset.
I don't want to disparage her GP, whom I have never met, but then neither has Rosemarie as far as I know. The Care Home has too many residents to be catered for by a single GP practice, so care responsibility is distributed as available and with no particular regard to the speciality of the GP. There is an alarming tendency for GPs (and any other professional) to get stuck in time at the point they finished their training, and I was very glad to find out that - at least for the next few months - a specialist doctor was available from the Community Mental Health Team would be available.
We met at the Care Home on 30th December. Very interesting. The original prescription for Donepezil had specified it should be taken in the morning. The doctor was surprised at this, since apparently it has a tranquilising effect initially then a stimulating effect some twelve hours later. It should be taken in the evening. There was also some evidence that it could be responsible for agitation and depression. He recommended that we start to reduce the dosage in a methodical way and see what effect it had on her behaviour, and then move on to looking at the Sertraline, which could also be contributing to the problems.
He seemed a very intelligent, sensible person and my daughter and I left the meeting generally satisfied and relieved. The only cloud on the horizon was that it was unlikely this level of support would last.
As part of the continuing break-up of the NHS, the responsibility for Mental Health Care for all Care Home residents has to be transferred to the care of the assigned GP by some date in the spring.
Her care will then be in the hands of someone with no specialist knowledge at all.
posted by Other Kosh at 11:37 am
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