Issue 36 / 17 September 2012

FOR vulnerable residents in aged care facilities, a missed page at the end of a fax can lead to a medication mix-up with potentially devastating consequences.

It was shocking enough to see the recent report on the ABC’s Lateline that thousands of dementia patients may be dying prematurely due to the routine prescription of antipsychotic drugs. But, sadly, our work at the Centre for Health Systems and Safety Research, at the University of NSW, shows that this may be just the tip of the iceberg in terms of poor medication practices in aged care homes.

We have been undertaking research in a number of residential aged care facilities to look at the challenges they face in being able to safely deliver all types of medications to residents.

What we have found is an archaic, paper-based system that relies heavily on faxing medication charts back and forth between community pharmacies, GPs and the facilities because there is currently no way of doing this electronically.

We’ve witnessed staff spending hours at their desks transcribing clinical information from paper to computer and vice versa. Some told us of cases where faxed pages had gone missing, or had been sent elsewhere. Doctors’ handwritten notes on complicated medication charts, covered with multiple stickers and crossings out, were often almost indecipherable.

It’s a system at high risk of failure. Common problems we have seen are double dosing — where patients are prescribed the same medication by different health care providers — and medications being omitted because the necessary prescribing instructions aren’t passed efficiently down the line.

Residents are particularly at risk of medication errors like these when they transition from one carer to another, such as from the supervision of a GP to a hospital and back.

This is worldwide problem. One UK study reported that 70% of residents across 55 aged care facilities had encountered at least one medication error.

Ordering and dispensing medication should be a relatively simple process, but in aged care facilities no one is taking ownership of this issue. Responsibility for medication is spread across multiple groups — GPs, hospitals, nurses and aged care staff — but in the end it’s usually underinformed relatives who are left to pick up the pieces.

I’m not saying doctors and staff don’t do their best — they do. However, to date no one has looked at the chaotic processes used to deliver medication to the elderly. It’s time this antiquated system was brought up to speed as we brace for the challenges of aged care into the future.

Computerised medical records have reduced prescribing errors in GP surgeries and the Centre for Health Systems and Safety Research has shown that electronic medication records can reduce more than 50% of these errors in hospitals. Now it’s time to introduce electronic information systems throughout the aged care system.

To provide good care to these residents, we need good information which travels with a resident as he or she passes from hospital to aged care facility and back. This information needs to be communicated in a way that can be shared and is legible, auditable and accountable.

That means designing clinical information systems that are unique to aged care, linking hospitals, GPs and pharmacies outside the facilities. Using hospital-based systems has not worked well as they don’t cater for the collaborative nature of aged care. It is time we prioritised the design of systems suited to this environment.

We also need to provide sufficient support for staff and to redesign work processes so that technology makes them more, rather than less, efficient. This can be as simple as teaching staff how to generate useful reports from the computer rather than leaving the information locked in the system, as happens all too frequently.

Aged care is an area that has been seriously neglected in terms of research into and monitoring of medication safety. The chaotic paper-based system makes reviews and audits extremely difficult. Information is continually collected but rarely used to improve care processes.

Some relatively simple changes have the potential to make a great deal of difference.

Technology is providing unprecedented opportunities to work in better ways across all areas of health care, and medication safety has to be the core priority.

For people in our residential aged care facilities, it’s nothing more than they deserve.

Professor Johanna Westbrook is the director of the Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, University of NSW.

Posted 17 September 2012

3 thoughts on “Johanna Westbrook: Cost of archaic care

  1. John Raftos says:

    Most studies show that the incidence of prescribing errors increases with computer prescribing.

  2. JD says:

    This problem is not just restricted to aged care facilities.
    I’m yet to see a patient with chronic problems living at home whose medication list from the hospital discharge summary, GP, and other specialists actually tally with what the patient is taking.
    I don’t see how an electronic system is going to help, unless individual health care providers painstakingly go through a patient’s medications (if necessary, with the bottles/packets they have at home). This won’t happen until the time needed is properly remunerated.

  3. Johanna Westbrook says:

    Recent studies have shown electronic prescribing significantly reduces prescribing errors.

    Westbrook JI, Reckmann M, Ling L, Runciman W, Burke R, Lo C, Baysari M, Braithwaite J, Day RO. (2012) Effects of two commercial electronic prescribing systems on prescribing error rates in hospital inpatients: a before and after study. PLoS Medicine,9(1): e1001164.

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