Aged Care Essentials Article | Resolving Medication Related Problems

Medication errors are identified as high risk and high occurrence in aged care. All organisations should be committed to implementing quality systems to minimise the potential risk. The appropriate use of medication can treat disease and/or control symptoms thereby improving health and/or comfort.

However, the physiological effects of an ageing body limit kidney and liver function, leaving an older person more vulnerable to adverse events related to medication administration. Additionally, in the aged care environment, there is a high prevalence of polypharmacy associated with comorbidity, which significantly increases the risk of medication side effects and subsequent adverse life quality for consumers.

Monash University’s Centre for Medicine Use and Safety recently conducted a systematic review of the Australian Government funded Residential Medication Management Review (RMMR) program. An RMMR is an assessment undertaken to identify and resolve Medication Related Problems (MRPs) that affect residents of aged care facilities. The Monash University review suggests that comprehensive RMMRs identify 2.7 to 3.9 MRPs per resident.[1] This underscores the need for aged care providers to explore opportunities to strengthen their medication management systems and prevent MRPs.

Digital System Considerations

 When considering the effectiveness of medication systems in reducing MRPs, providers may contemplate moving from a paper-based system to a digital system to assist in mitigating risks. Considerations for digital systems include:

• An end-to-end solution that consolidates the many steps of medication management into one system.
• Clear information layout that is easy to understand.
• Medication/dose shown in real time with live updates from the GP and pharmacy to reduce errors in administration.
• Staff record of administration – digital systems can be programmed to: determine the designation of the person administering the medication; enable packed medication count for assistants in nursing; enable dual signature; and automatically encode requirements and restrictions relating to medication types, outcomes and administration.
• Flexible options – allows flexible options for administration such as dose round duration.
• Point in time records – provides up-to-date data in one accessible location (no searching through progress notes) and enables progress notes to be accessible during the dose rounds, reduces double-handling and the risk of dual system errors and enables continuation of work flow. Should include safeguards to force the documentation of PRN (Pro Re Nata or as needed) effectiveness.
• Forced observations – enforces the recordings of clinical and care recordings for example BGL (Blood Glucose Level) and pulse rate evidencing the requirement for administering or withholding medication.
• Access to current drug information during dose round.
• Security levels to support safe and appropriate access by users.
• Tracking and completion of medication incidents.
• Stock ordered at the point of administration, removing the need for an external ordering process and reducing risk of failure to administer due to ’lack of stock’.
• Allows Doctor to access and track messages from staff.
• On demand reporting available to allow the Leadership Team to generate reporting as required.
• Stock maintenance – provides electronic audit tools for stock and automatically calculates balances with record of administration.
• Comprehensive after-market support and system maintenance.
• System integration with the clinical management software to support a streamlined approach to data collection and reduce information system error.

Regardless of the type of system, it is imperative that the medication management system in your organisation is clearly defined and processes are stringently followed and monitored. This practice will reduce the likelihood of consumers being exposed to medication related risks.  

A digital medication management system may assist with strengthening medication management at your Home and may reduce the number of MRPs. When considering your medication system, we recommend that you:

• ensure you appropriately scope out your system requirements
• consult with your pharmacist, GP and staff responsible for medication administration
• research at least three systems to see what best meets your needs

visit providers so that you can see medication systems in action and gather some ‘hard data’ on system benefits.

[1] Further details on the study are in the September 2019 volume of the Australasian Journal on Ageing, Process, impact and outcomes of medication review in Australian residential aged care facilities: A systematic review, vol. 38 no. S2

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