• • • • • • We recommended that the institution inform its doctors about the expert’s opinion suggesting that medications which cannot be split accordingly be prescribed in higher dosages or be replaced with medications with a similar mechanism of action. In this way, the splitting of pills with a complex release of active substances would be avoided. We recommended that the institution inform its doctors about the expert’s opinion suggesting that the description of indications for administering medications be equipped with the maximum permissible number of daily occasional medications and thus reduce the possibility of excessive administering of medications if the prescription is misunderstood. When prescribing occasional medications, it would be sensible to provide indications for administering individual medications which would be understandable to medical and care staff. We suggested that the wishes of residents to be moved into another room be considered with regard to possibilities if they did not get along with their fellow residents. We recommended that the institution inform its doctors about the expert’s opinion suggesting that it would be sensible to use higher dosages of one of the prescribed medications in the case of the need to prescribe medications with a similar effect on the central nervous system in dosages lower than the maximum permitted recommended daily doses in order to prevent simultaneous prescribing of several different medications due to the risk of unwanted interactions between medications. It was recommended that the institution inform its doctors about the expert’s opinion suggesting that it would be sensible to avoid prescribing medications with prolonged excretion due to the risk of accumulation in the body. We recommended that the institution inform its doctors about the expert’s opinion suggesting that when prescribing occasional medications it would be sensible to use the lowest still effective dosages of medications and repeat occasional administering several times (e.g. when prescribing the sleeping pills Zolpidem). General proposals or recommendations forwarded by the expert are particularly important and mainly serve as an appeal to the competent ministry to immediately commence resolving the issues determined during the NPM’s visit (some of which we have been pointing out for some time): • • At least one medical and care staff member should be constantly present on each secure ward of the social care institution during the night time in order to provide assistance to persons with nerve function impairments who are unable to call the staff with the use of technical devices, but are only able to draw attention to their own needs vocally. By ensuring a higher number of medical and care staff in the evening, it would be possible to shorten the time intended for rest and adjust this time to the expected need for sleep of the elderly people (up to eight hours per night). 31 2.1 VISITS TO RETIREMENT HOMES We particularly highlight the special recommendations given by the expert when visiting individual institutions, especially those that were noted during several visits: