Rates of PRN Medication Administration in Australian Residential Aged Care

Abstract Background A medication omission is an event where a prescribed medication is not taken before the next scheduled dose. Medication omissions are typically classed as errors within Residential Aged Care (RAC) homes, as they have the potential to lead to harm if poorly managed, but may also stem from good clinical decision-making. This study aimed to quantify the incidence, prevalence, and types of medication omissions in RAC homes on a national scale, using a New Zealand-based sample. Methods We conducted retrospective pharmacoepidemiology of de-identified medication administration e-records from December 1st 2016 to December 31st 2017. Four tiers of de-identified data were collected: RAC home level data (ownership, levels of care), care staff level data (competency level/role), resident data (gender, age, level of care), and medication related data (omissions, categories of omissions, recorded reasons for omission). Data were analysed using SPSS version 24 and Microsoft Excel.Results A total of 11, 015 residents from 374 RAC homes had active medication charts; 8,020 resided in care over the entire sample timeframe. A mean rate of 3.59 medication doses were omitted per 100 (±7.43) dispensed doses/resident. Seventy-three percent of residents had at least one dose omission. The most common omission category used was ‘not-administered’ (49.9%), followed by ‘refused’ (34.6%). The relationship between ownership type and mean rate of omission was significant (p=0.002), corporate operated RAC homes had a slightly higher mean (3.73 versus 3.33), with greater variation. The most commonly omitted medications were Analgesics and Laxatives. Forty-eight percent of all dose omissions were recorded without a comment justifying the omission. Conclusions This unique study is the first to report rate of medication omissions per RAC resident over a one-year timeframe. Although the proportion of medications omitted reported in this study is less than previously reported by hospital-based studies, there is a significant relationship between a resident’s level of care, RAC home ownership types, and the rate of omission.

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Design Challenges for Electronic Medication Administration Record Systems in Residential Aged Care Facilities

Applied Clinical Informatics ◽

10.4338/aci-2014-08-ra-0062 ◽

2014 ◽

Vol 05 (04) ◽

pp. 971-987 ◽

Cited By ~ 8

Author(s):

E. Lehnbom ◽

K. Oliver ◽

A. Georgiou ◽

C. Rowe ◽

T. Osmond ◽

...

Keyword(s):

Decision Support ◽

Medication Administration ◽

Aged Care ◽

Residential Aged Care ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities ◽

Design Challenges ◽

Roll Out ◽

Electronic Medication Administration

SummaryIntroduction: Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements.Methods: A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system.Results: The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues.We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows.Discussion: Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.Citation: Tariq A, Lehnbom E, Oliver K, Georgiou A, Rowe C, Osmond T, Westbrook J. Design challenges for electronic medication administration record systems in residential aged care facilities: a formative evaluation. Appl Clin Inf 2014; 5: 971–987http://dx.doi.org/10.4338/ACI-2014-08-RA-0062

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Nursing staff work patterns in a residential aged care home: a time–motion study

Australian Health Review ◽

10.1071/ah15126 ◽

2016 ◽

Vol 40 (5) ◽

pp. 544 ◽

Cited By ~ 3

Author(s):

Siyu Qian ◽

Ping Yu ◽

David Hailey

Keyword(s):

Nursing Care ◽

Nursing Staff ◽

Care Home ◽

Medication Administration ◽

Aged Care ◽

Verbal Communication ◽

Residential Aged Care ◽

Work Patterns ◽

Time Motion ◽

Motion Study

Objective Residential aged care services are challenged by an increasing number of residents and a shortage of nursing staff. Developing strategies to overcome this challenge requires an understanding of nursing staff work patterns. The aim of the present study was to investigate the work processes followed by nursing staff and how nursing time is allocated in a residential aged care home. Methods An observational time–motion study was conducted at two aged care units for 12 morning shifts. Seven nurses were observed, one per shift. Results In all, there were 91 h of observation. The results showed that there was a common work process followed by all nurse participants. Medication administration, documentation and verbal communication were the most time-consuming activities and were conducted most frequently. No significant difference between the two units was found in any category of activities. The average duration of most activities was less than 1 min. There was no difference in time utilisation between the endorsed enrolled nurses and the personal carers in providing nursing care. Conclusion Medication administration, documentation and verbal communication were the major tasks in morning shifts in a residential aged care home. Future research can investigate how verbal communication supports nursing care. What is known about the topic? The aging population will substantially increase the demand for residential aged care services. There is a lack of research on nurses’ work patterns in residential aged care homes. What does this paper add? The present study provides a comprehensive understanding of nurses’ work patterns in a residential aged care home. There is a common work process followed by nurses in providing nursing care. Medication administration, verbal communication and documentation are the most time-consuming activities and they are frequently conducted in the same period of time. Wound care, physical review and documentation on desktop computers are arranged flexibly by the nurses. What are the implications for practitioners? When developing a task reallocation strategy to improve work efficiency, effort can be put into tasks that can be arranged more flexibly.

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Evaluation of a hybrid paper–electronic medication management system at a residential aged care facility

Australian Health Review ◽

10.1071/ah14206 ◽

2016 ◽

Vol 40 (3) ◽

pp. 244 ◽

Cited By ~ 7

Author(s):

Rohan A. Elliott ◽

Cik Yin Lee ◽

Safeera Y. Hussainy

Keyword(s):

Medication Management ◽

Care Facility ◽

Medication Administration ◽

Aged Care ◽

Management Systems ◽

Residential Aged Care ◽

Dose Administration ◽

Medication Administration Errors ◽

Residential Aged Care Facility ◽

Electronic Medication Administration

Objectives The aims of the study were to investigate discrepancies between general practitioners’ paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper–electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5–12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18 min to 98 h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper–electronic medication management systems, in which prescribers’ orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care facilities. The accuracy and safety of these systems has not been studied. What does this paper add? The present study identified discrepancies between general practitioners’ orders and pharmacy-prepared electronic medication administration charts, back-up paper medication charts and dose-administration aids, as well as delays between ordering, charting and administering medicines. Discrepancies and delays sometimes led to medication administration errors. What are the implications for practitioners? Facilities that use hybrid systems need to implement robust systems for communicating medication changes to their pharmacy and reconciling prescribers’ orders against pharmacy-generated medication charts and dose-administration aids. Fully integrated, paperless medication management systems, in which prescribers’ electronic medication orders directly populate an electronic medication administration chart and are automatically communicated to the facility’s pharmacy, could improve patient safety.

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Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm9041053 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1053 ◽

Cited By ~ 4

Author(s):

Janet K. Sluggett ◽

Ria E. Hopkins ◽

Esa YH Chen ◽

Jenni Ilomäki ◽

Megan Corlis ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Medication Administration ◽

Aged Care ◽

Residential Aged Care ◽

Medication Regimen ◽

Term Care ◽

Randomized Controlled ◽

The Impact

In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we evaluated the impact of structured medication regimen simplification on medication administration times, falls, hospitalization, and mortality at 8 residential aged care facilities (RACFs) at 12 month follow up. In total, 242 residents taking ≥1 medication regularly were included. Opportunities for simplification among participants at 4 RACFs were identified using the validated Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE). Simplification was possible for 62 of 99 residents in the intervention arm. Significant reductions in the mean number of daily medication administration times were observed at 8 months (−0.38, 95% confidence intervals (CI) −0.69 to −0.07) and 12 months (−0.47, 95%CI −0.84 to −0.09) in the intervention compared to the comparison arm. A higher incidence of falls was observed in the intervention arm (incidence rate ratio (IRR) 2.20, 95%CI 1.33 to 3.63) over 12-months, which was primarily driven by a high falls rate in one intervention RACF and a simultaneous decrease in comparison RACFs. No significant differences in hospitalizations (IRR 1.78, 95%CI 0.57–5.53) or mortality (relative risk 0.81, 95%CI 0.48–1.38) over 12 months were observed. Medication simplification achieves sustained reductions in medication administration times and should be implemented using a structured resident-centered approach that incorporates clinical judgement.

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Medication omission rates in New Zealand Residential Aged Care Homes: a national description

10.21203/rs.2.15999/v1 ◽

2019 ◽

Author(s):

Stephanie M Garratt ◽

Ngaire M Kerse ◽

Kathryn Peri ◽

Monique F Jonas

Keyword(s):

Decision Making ◽

New Zealand ◽

Clinical Decision Making ◽

National Level ◽

Clinical Decision ◽

Medication Administration ◽

Aged Care ◽

Care Staff ◽

Care Homes ◽

Residential Aged Care

Abstract Background Medication administration is a key service offered to individuals residing in residential aged care homes (RAC homes). A medication omission is an event where a prescribed medication is not taken by a resident before the next scheduled dose. Medication omissions are typically classed as errors, they have the potential to lead to harm if poorly managed, but may also stem from good clinical decision-making. Studies that critically appraise or support medication omissions in healthcare settings are limited. There is uncertainty around which medication omissions are problematic and how many on average a patient should experience. There have been several hospital-based studies, with limited sample sizes, timeframes, and inconsistent reporting of omissions. As the first population-level, RAC Home-specific study of its kind, this study quantifies the incidence, prevalence, and types of medication omissions in RAC homes on a national scale. Methods A retrospective review of de-identified, medication administration e-records from December 1 st 2016 to December 31 st 2017 was conducted. Demographic details of residents, care staff competency levels, medications, and RAC ownership types were included in the review and analysis. Results A total of 11, 015 residents from 374 RAC homes had active medication charts; 8,020 resided in care over the entire data collection period. A mean rate of 3.40 medications doses were omitted per 100 dispensed medications doses per resident (s.d. 7.27). Approximately 73% of residents had at least one dose omission. The most common selected omission category was ‘not-administered’ (49.9%), followed by ‘refused’ (34.6%). The mean rate of omission was found to be slightly higher in corporate operated RAC Homes (3.73 versus 3.33), with greater variation. The most commonly omitted medications were Analgesics and Laxatives. Forty-eight percent of all dose omissions were recorded without a comment justifying the omission. Conclusions Compared to other studies medication omissions within RAC homes in New Zealand are not as common as previously proposed. This study sets out the first national-level rate of medication omissions per resident over a one-year timeframe. Subsequent studies will address the medications omitted, the clinical significance of omissions and the place of medication omissions within clinical decision-making.

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Medication administration issues in residential aged care – four cases

10.33879/jcgg.2018.1804 ◽

2018 ◽

Vol 9 (4) ◽

pp. 156-159

Author(s):

Elizabeth Hotham ◽

Renae Lloyd ◽

Emilio Petito ◽

Vijayaprakash Suppiah

Keyword(s):

Medication Administration ◽

Aged Care ◽

Residential Aged Care

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Medication administration process in a residential aged care home: An observational study

Journal of Nursing Management ◽

10.1111/jonm.12632 ◽

2018 ◽

Vol 26 (8) ◽

pp. 1033-1043 ◽

Cited By ~ 2

Author(s):

Siyu Qian ◽

Ping Yu ◽

David Hailey ◽

Ning Wang ◽

Anol Bhattacherjee

Keyword(s):

Observational Study ◽

Care Home ◽

Medication Administration ◽

Aged Care ◽

Residential Aged Care

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Medication omission rates in New Zealand Residential Aged Care Homes: a national description

10.21203/rs.2.15999/v2 ◽

2020 ◽

Author(s):

Stephanie M Garratt ◽

Ngaire M Kerse ◽

Kathryn Peri ◽

Monique F Jonas

Keyword(s):

New Zealand ◽

Clinical Decision Making ◽

Home Ownership ◽

Medication Administration ◽

Aged Care ◽

Care Staff ◽

Residential Aged Care ◽

Level Of Care ◽

Ownership Type ◽

Level Data

Abstract Background A medication omission is an event where a prescribed medication is not taken before the next scheduled dose. Medication omissions are typically classed as errors within Residential Aged Care (RAC) homes, as they have the potential to lead to harm if poorly managed, but may also stem from good clinical decision-making. This study aimed to quantify the incidence, prevalence, and types of medication omissions in RAC homes on a national scale, using a New Zealand-based sample. Methods We conducted retrospective pharmaco-epidemiology of de-identified medication administration e-records from December 1st 2016 to December 31st 2017. Four tiers of de-identified data were collected: RAC home level data (ownership, levels of care), care staff level data (competency level/role), resident data (gender, age, level of care), and medication related data (omissions, categories of omissions, recorded reasons for omission). Data were analysed using SPSS version 24 and Microsoft Excel.Results A total of 11, 015 residents from 374 RAC homes had active medication charts; 8,020 resided in care over the entire sample timeframe. A mean rate of 3.59 medication doses were omitted per 100 (±7.4) dispensed doses/resident (s.d. 7.43). Seventy-three percent of residents had at least one dose omission. The most common omission category used was ‘not-administered’ (49.9%), followed by ‘refused’ (34.6%). The relationship between ownership type and mean rate of omission was significant (p=0.002), corporate operated RAC homes had a slightly higher mean (3.73 versus 3.33), with greater variation. The most commonly omitted medications were Analgesics and Laxatives. Forty-eight percent of all dose omissions were recorded without a comment justifying the omission. Conclusions This unique study is the first to report rate of medication omissions per RAC resident over a one-year timeframe. Although the proportion of medications omitted reported in this study is less than previously reported by hospital-based studies, there is a significant relationship between a resident’s level of care, RAC home ownership types, and the rate of omission.

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