SUMMARY - Safe Medications Management project: Key issues and ...

The Centre for Policy on Ageing (UK) reports and tools. London-based projects to improvemedication management through a “Single Assessment Process”; andThe nurse registration board for Ireland Comprehensive Guidance to Nurses and Midwives onMedication Management.The following themes were identified from these overseas documents. However Australian AgedCare services do not collect national data and so little is known on actual medication error rates.Medication errors (which can occur at many points from prescription through dispensing,packaging, storage and administration) and adverse events occur in residential aged carefacilities and among the elderly in the community with rates of 20% to 30% (of medicinesadministered) with up to 75% of residents in aged care affected. Errors were highest forpsychotropic, diabetes, and anticoagulant medications. Contributing factors included:o complex medication regimes with high numbers of individual drugs prescribed;o prescribing, charting, dispensing, and supply errors and inconsistencies;o medication information transfer problems where patients moved between settings(home, hospital, residential care);o workload levels and interruptions to those administering medications;o inadequate medication monitoring systems;o certain formulations (creams, liquids, aerosols) and changes to formulations (crushingtablets, emptying capsules).Strategies identified to reduce errors included:o Dose Administration Aids (although some studies suggest these cause errors),o integrated computerised prescription, order and entry (CPOE) systems linking theprescriber, dispenser and administrator,o electronic health records (with some qualified support),o pharmacist involvement in medication management systems for both residential andcommunity care,o multidisciplinary medication reviews and medication management systems,o pharmacist training of direct care staff in aged care medications and systems,o medication monitoring systems, ando reducing medication management staff workload and interruptions.The conclusions that can be drawn from this literature review include:There is no uniformity of guidance on medication management for nurses in aged careamongst the states/territories.APAC guidelines have differing authoritative credibility amongst professionals and healthauthorities.Little is known of actual medication error rates in Australian aged care.Multidisciplinary medication review and management systems; staff education bypharmacists, CPOE and other electronic systems and other tools may reduce medicationerrors.21