Introduction: Salford Care Homes Medical Practice (SCHMP) is a novel GP practice with 921 registered patients all of whom are care home residents. Research has shown that people with advanced dementia often suffer from untreated and undiagnosed pain and treating this can reduce symptoms of agitation. Fifty-four percent of the practices patients have a diagnosis of dementia, and as part of the practice's BPSD (behavioural and psychological symptoms of dementia) pathway pain is assessed and treated. As a result of this and other co-morbidities, approximately half of the practice's patients are prescribed paracetamol.
There is a high incidence of dysphagia related to stroke and dementia in care home residents so soluble or liquid medication is often required. Soluble Paracetamol and Co-Codamol contain high levels of sodium; a total daily dose of 4 g paracetamol contains more than the recommended maximum daily amount of 6 g of sodium. This is particularly relevant in care home patients —23% of SCHMP patients have a diagnosis of chronic kidney disease and 51% hypertension. Studies have shown that withdrawing soluble analgesia reduces blood pressure, leading to a UK medicines information service statement (May 2012) suggesting switching to low sodium alternatives.
Change strategies: A search was carried out in July 2012 of all patients on soluble analgesia using the electronic patient record. Thirty-four patients were identified and 33 switched to alternative liquid preparations. Clinicians were educated on the problems associated with soluble analgesia.
Change effects: A re-audit was carried out in November 2012. One patient was on soluble analgesia who had been identified in the initial audit and had a specific clinical need.
Conclusion: Care home residents commonly require analgesia in a liquid form. Prescribers should take into consideration the high sodium concentrations with soluble analgesia in this vulnerable group and switch to alternatives.