An investigation of medication information transfer and application in aged care facilities in an Australian rural setting.
BACKGROUND
As patients move within Australia's increasingly complex healthcare system, it is desirable that they receive uninterrupted, timely and accurate administration of medication. For this to occur, effective communication of medication information is required, and mechanisms must be in place to ensure timely administration. This study focused on these issues as they apply to patients being admitted to aged care facilities in an Australian rural setting, including investigation of the transfer and early application of information about their current medications (or 'medication information'). Electronic prescribing and associated information transfer may improve the transfer of medication information in the future; however, this study focused on the current situation in rural Australia.


METHODS
In this observational study, patient outcomes and participating nurses' experience of medication issues related to admissions to rural residential aged care facilities from an acute hospital, a rehabilitation facility, another aged care facility or the community were investigated. Data were collected using a customised questionnaire completed by nursing staff at participating aged care facilities.


RESULTS
Data relating to 59 individual patient transfers were obtained from 14 aged care facilities. A number of pathways for the communication of medication information were identified, with timely and effective information transfer occurring for most patients. However, one in five patients experienced a delay of up to 4 hours, and a limited number of incidents of inadequate information transfer were identified. While most patient transfers occurred with 12 or more hours notice, one in ten transfers occurred with no more than one hour of notice. Transfers were not evenly distributed among week days; however, very few transfers occurred after 5 pm on Friday. A number of staff reported that they had felt it necessary to act beyond their normal employee duties to ensure timely medication delivery to their aged care residents.


CONCLUSIONS
This study identified pathways used to transfer medication information about patients being admitted to aged care facilities, and also immediate responses to that information. The study indicates that these processes, while generally satisfactory, are at times less than ideal. Health professionals in rural Australia may be in an ideal position to develop and implement effective local responses to identified problems, by activating interprofessional links. The study also highlights the issue of aged care staff acting outside their designated role in an attempt to ensure timely medication administration to their patients, a potentially inefficient use of limited staff time.
Pierce
D
D
University of Melbourne, Ballarat, Victoria, Australia. d.pierce@unimelb.edu.au
Fraser
G
G
D000368:Aged; D002985:Clinical Protocols; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006282:Health Personnel / Q000458:organization & administration*; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D008875:Middle Aged; D010360:Patient Transfer / Q000458:organization & administration*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014739:Victoria
D004364:Pharmaceutical Preparations