“As a professional services pharmacist, I frequently take phone calls from rural aged care facilities who only have limited access to GPs, and where a one‑day‑a‑week GP visit is viewed as a luxury.” Christine Veal
nursing staff, together with the pharmacy medication profile. The fundamental principle is that every step is designed to facilitate the “7 rights of medication management” in a clear and intuitive way: person, medication, dose, time, route, documentation, outcome. The single central medication profile is an important tool for a residential aged care facility when considering medication misadventure vulnerabilities. The single, central profile ensures information is consistent across all components used for medication management. This provides confidence to an organisation that a resident’s medication information is current, consistent and accurate. Admission to an aged care facility or being transferred between care settings increases the risk of medication errors. More than 40 per cent of medication errors in hospitals are believed to result from inadequate medication information on admission, transfer and discharge.3 The steps in collating a medication profile are straightforward. For a newly admitted resident the steps include obtaining and verifying a patient’s medication history documentation and writing a medication chart. Also important is to ensure a clear colour photo of every resident is taken
on admission, which allows nurses to confirm identity during the medication administration process. These are the simple steps. The challenge, however, comes in the gathering, organising and communication of medication information across the aged care team where not all members of the healthcare team are on the premises or always easily accessible. Managing medication changes is not straightforward. As a professional services pharmacist, I frequently take phone calls from rural aged care facilities who only have limited access to GPs, and where a one-day-aweek GP visit is viewed as a luxury.
Multiple medications How does an organisation ensure appropriate clinical governance in a constantly fluctuating environment with multiple medication changes that also require constant faxing of medication charts? After frequent faxing charts become illegible, missing vital resident information, facility section information, and the now black and white photos become irrelevant. More importantly though multiple faxed charts mean there are increased risks to the resident due to multiple versions of medicine on the medication chart.
This is a constant source of frustration among pharmacists, aged care staff and GPs. Faxes are insecure methods of communication, plain and simple. I have even heard of medication charts containing private and personal medical information having been faxed to the local newsagent because a staff member used the incorrect auto-dial function on the fax machine. New privacy legislation makes this an even greater risk to the facility and the patient’s healthcare provider. Secure electronic communication and a single electronic health record for each patient is generally believed to contain more accurate information with easy retrieval. They also provide date and timestamped tracking of medication orders and communication. However, it is important to remember any system is only as good as the framework, processes and governance that support it. In addition to designing and implementing an IT system, an organisation should also consider defining all processes, allocating responsibility, identifying expected time frames, training key staff and evaluating all these process.
Medication administration The non-signing of medicines is an ongoing issue in aged care. If the administration of a medicine to a resident is not accounted for, it is difficult for supervising staff to determine whether the medication was not administered due to oversight, or withheld for a reason, or whether it was administered but simply not signed for. There are many reasons a medication may be omitted: stress, high workload, fatigue, poor lighting and noise are all identified as contributing factors. A Victorian study found that interruptions and distractions contributed to 25 per cent of administration errors.4
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