Prescribing to Vulnerable Adults
A vulnerable adult is defined in "No Secrets‟ Governments Guidance of Adult Abuse as:
"someone who is aged 18 and over, who is or may be in need of community care services by reason of mental or other disability, age, or illness and who is or may be unable to take care of him/herself and protect him/herself against significant harm or exploitation and those who are ill or dependent upon another for any of the aids to daily living"
Vulnerable patients are commonly on potentially harmful medications such as; antipsychotics, antidepressants, analgesics, sedatives, and anticonvulsants. Vulnerable patients are at higher risk of intentional and accidental overdose. In recent months there have been a number of cases dealt with by the performance team in which GPs have received criticism for prescribing potentially harmful drugs to vulnerable patients who have taken overdoses.
Vulnerable patients can often put pressure on GPs to prescribe medications which the GP is reluctant to prescribe. The GMC guidance on prescribing states-
"If a patient asks for a treatment that the doctor considers would not be of overall benefit to them, the doctor should discuss the issues with the patient and explore the reasons for their request. If, after discussion, the doctor still considers that the treatment would not be of overall benefit to the patient, they do not have to provide the treatment. But they should explain their reasons to the patient, and explain any other options that are available, including the option to seek a second opinion."
The LMC advises practices to consider the following mechanisms which are available to reduce the risk of harm for prescribing to vulnerable patients, these include;
- Restrict the use of potentially harmful drugs
- Restrict the quantities and frequency of drugs prescribed
- Restrict the use of repeat prescriptions for potentially harmful drugs
- Regular reviews of medication for vulnerable patients
- Negotiate contracts with patients regarding the quantity and frequency of prescriptions
- Nominate one doctor with a specialist interest to lead prescribing for vulnerable patients