Medication mistakes show 'we can't get basics right'

Nearly half of complaints about medication use in aged care relate to basics such as administering to the right resident at the right time.

University of Tasmania Associate Professor Juanita Breen told the National Medicines Symposium that of out of more than 15,000 complaints to the Aged Care Quality and Safety Commission in 2019-20, there were 1224 medication complaints and 545 related to “basic medicine administration: right resident, right medicine, right dose, right time, right route, right documentation”.

Three categories of medication-related issues accounted for 61 per cent of all complaints, she said.

Medicine given late, delayed or even missed completely accounted for more than a quarter (27 per cent) of complaints.

Inadequate medication management systems, processes or policies made up 22 per cent of complaints, said Assoc. Prof. Breen. This included “medicines going missing or a trolley being left unlocked”.

Reports about chemical restraint, including over-sedation, made up 14 per cent of complaints.

Medicine-related issues were the top-ranked complaint issue in aged care over the past five years.

“This research is vitally important as it reports what matters to consumers, mostly relatives who advocate for those living in aged care,” Assoc. Prof. Breen told the Australian Journal of Pharmacy.

“The reality is it’s the basic things like having pain medication or palliative treatment given on time or getting a trained staff member to give an insulin shot …”

Read more: Reaction to the Federal Budget’s aged care provisions

Assoc. Prof. Breen said the complaints showed the lack of training of staff in aged care homes.

“This stresses the need for pharmacists performing QUM [Quality Use of Medicines] services to upskill staff on basic rights of administration such as medication timing and processes.

“Staff tell me they receive training infrequently and when they do it’s on topics like anticoagulants or digoxin – while important basic medication management topics need coverage first and foremost.”

The federal government allocated $17.7 billion to aged care reform in the 2021 Federal Budget, to be spent over the next five years.

In 2019, hellocare.com.au reported that a survey of more than 700 NSW nurses found 83 per cent had “witnessed a medication error in residential aged care”.

A University of South Australia report concluded that 98 per cent of aged care residents had experienced a “medication-related problem”.

The same report states that 17 per cent of unplanned hospital admissions by people living in residential aged care are the result of being given an inappropriate medicine.

According to the Pharmaceutical Society of Australia, medication errors cost Australia more than $1.2 billion every year.”

Read more: Aged care system overhaul

Professor Briony Dow told australianageingagenda.com.au that the Royal Commission into Aged Care Quality and Safety showed the need to establish trust in the aged care system. She quoted research by the National Ageing Research Institute (NARI), which showed that one in three people in residential care reported “their care needs were only sometimes met, and at least three in every five respondents had one or more main concerns either directly or indirectly indicative of substandard care”. 

“Concerns included staff (47 per cent), fees and services (40 per cent), medical care (36 per cent), dignity and respect (24 per cent), rooms (24 per cent), lack of choice (18 per cent), personal care (17 per cent) and the facility (16 per cent),” said Prof. Dow.

Less than a quarter of residents knew how to lodge a complaint, were comfortable doing so and certain action would be taken. 

“It is critically important government carefully considers the commissioners’ many recommendations for change including the appointment of a complaints commissioner in the quality regulator, a single comprehensive assessment process and a star-rating performance system to allow comparison of services.”

Read more: Older Australians want to stay at home, not go into aged care

Prof. Dow called for “fundamental workforce reforms” in dementia care to ensure a “properly skilled, adequately remunerated workforce” and support for staff who are “trying to do the best they can in a system of care that is broken”.

Human Rights Watch says the commission called out the appalling use of ‘chemical restraint’, where aged care facilities give older people drugs to control their behaviour even though the drugs are not required to treat medical symptoms.

The royal commission stated: “Urgent reforms are necessary to protect older people from unnecessary, and potentially harmful, physical and chemical restraints.”

But Human Rights Watch says the government must outlaw chemical restraint and the only way to end the abusive practice is to hold aged care providers accountable.

Do you know how to complain about aged care facilities? Are you confident that any complaints would be satisfactorily resolved?

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Written by Will Brodie



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