Reducing Antipsychotic Prescribing in Care Home Residents living with Dementia

Bradford District Care NHS Foundation Trust

Project summary

This system-wide quality improvement programme (consisting of two linked projects) was developed to reduce inappropriate antipsychotic prescribing for Behavioural and Psychological Symptoms of Dementia (BPSD) in care home residents across Bradford District and Craven.

The project was initiated in response to local prescribing data showing Bradford as a national outlier, with 14.9% of people with dementia prescribed antipsychotics in March 2024 compared with 9% across England. This highlighted a need to improve medicines safety, reduce antipsychotic prescribing, and enhance person-centred dementia care in care homes.

The project focused on identifying care home residents prescribed antipsychotics for Behavioural and Psychological Symptoms of Dementia (BPSD) and reviewing whether these medicines were clinically appropriate. Antipsychotics were reviewed assessing indication, duration of treatment, risks and benefits, and the views of residents, families, and care home staff. Structured tapering and withdrawal plans were implemented and closely monitored in conjunction with local GPs. Care home staff were supported in non-pharmacological approaches to manage distressed behaviours, including understanding the unmet needs of residents.

Further funding enabled a linked project exploring the influence and attitudes of care home staff on prescribing practice and deprescribing success.

Qualitative feedback from care home staff and family members reported improved engagement, communication and quality of life for residents following deprescribing. The project has also improved consistency of care through standardised review processes and strengthened multidisciplinary decision-making.

The project achieved measurable system-wide impact, reducing antipsychotic prescribing in dementia across Bradford from 14.9% in March 2024 to 12.3% in March 2026, the lowest level recorded locally since 2018.

Deprescribing antipsychotics also potentially reduced anticholinergic burden (ACB), lessening exposure to medicines associated with confusion, cognitive impairment, and falls.

Qualitative interviews with carers further identified barriers and enablers to deprescribing, including workforce pressures, family expectations, and the importance of dementia training and non-pharmacological interventions.

Antipsychotics are relatively inexpensive, so cost savings were low, however reduction in medication-related harm through safer prescribing, improved quality of dementia care, and the potential avoidance of falls and hospital admissions are tangible benefits.

This low-cost, scalable intervention delivered through existing NHS and care home workforce structures demonstrates that sustainable reductions in inappropriate antipsychotic use can be achieved through collaborative evidence-based medicines optimisation embedded within routine care in a care home setting.