RESEARCH looking into factors related to continuity of medication when patients transfer from hospitals to residential aged-care facilities (RACFs) has highlighted shortcomings in transition-of-care processes, resulting in missed or delayed doses of medication for nearly one in four patients.
The team, led by Adjunct Assoc Prof Rohan Elliott from the Pharmacy Department at Austin Health, reviewed cases for 397 patients from 11 hospitals in Victoria two days after they were discharged from hospital.
They found that 23% of patients had one or more missed or significantly delayed doses, with 5% missing out on one or more high-risk medications (such as opioids, anticoagulants, levodopa and insulin), and 13% on moderate-risk medication (such as antimicrobials and non-opioid pain killers).
The risk of missed or delayed doses was reduced when hospitals supplied discharge medications in original packs and an interim medication administration chart (IMAC), and when community pharmacies delivered repackaged medications on the day of discharge.
However, only 52% of patients had their aged care medication charts prepared or updated on the day of transfer, with updated medications delivered to the RACF from their community pharmacy provider (packed in DAAs) for only 46% patients.
Interestingly, they found that having a GP or locum do patients' RACF medication charts on the day of discharge increased the risk of missing or delayed doses, likely due to GPs being unavailable until later in the day.
"Hospitals should be encouraged and supported to provide IMACs to facilitate timely and safe administration of medications, and RACFs should be encouraged and supported to use them routinely," the researchers suggested.
The team pointed to a lack of clear guidance and support for the use of IMACs from state and Commonwealth Governments and their respective health and aged care safety and quality bodies, as well as a lack of standardisation of IMAC procedures, as major barriers to wider implementation.
With a median time from discharge to first medication dose required of less than three hours, it was also recommended that hospitals be enabled to provide up to seven days of interim medication supply aligned with a seven-day IMAC, to enhance continuity of medication administration.
The team called for barriers to implementation of these approaches to be addressed.
The paper is available HERE. KB
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