title: Medicines in Australian nursing homes: a cross-sectional observational study of the accuracy and suitability of re-packing medicines into pharmacy-supplied dose administration aids.
abstract: BACKGROUND
  Though staff at Australian nursing homes (NHs) commonly administer medicines that have been re-packed into dose administration aids (DAAs) that organize medicines according to dose schedule, these pharmacy-supplied devices have not been extensively evaluated in the Australian setting.
  
  
  OBJECTIVE
  To audit the accuracy and suitability of re-packing medicines into DAAs (blister packs or sachets) for NHs and identify the proportion of DAAs with inaccurate or unsuitable medicine re-packing.
  
  
  METHODS
  Between January and June 2011, pharmacist researchers visited 49 randomly and purposively selected NHs from rural, regional, and metropolitan Victoria (Australia) to audit a sample of residents' newly prepared DAAs that contained all of their regularly re-packed medicines for 1 week. Over 1 or 2 days, the pharmacy-supplied DAAs were compared with the current prescriber-prepared NH medicine chart. Any occurrences of inaccurately re-packed medicines (discrepancies, with verification as necessary) or unsuitable medicine re-packing were recorded as DAA incidents and descriptive statistics was used to analyze the data.
  
  
  RESULTS
  Six hundred and eighty-four incidents occurring in 457 DAAs were detected from a total of 3959 DAAs audited for 1757 residents (incident rate of 11.5% of DAAs) from 49 participating NHs. Incidents were detected in 10.5% of blister packs and 14.5% of sachets. The top five incidents were unsuitable re-packing according to pharmaceutical guidelines (50.1%); added medicine (9.8%); incorrect quantity re-packed (5.4%); omitted medicine (5.3%); and damaged medicine (5.1%).
  
  
  CONCLUSIONS
  The incident rate of inaccurate or unsuitable medicine re-packing within DAAs supplied to NHs for use in medicine administration was higher than in previous research. Recommendations include using current findings in conjunction with further research to develop a quality improvement initiative to reduce DAA incident rates and improve NH standard of care.
authors.affiliation: Centre for Medicine Use and Safety, Monash University Melbourne, Australia.
authors.forename: Julia Fiona-Maree
authors.initials: JF
authors.lastname: Gilmartin
authors.forename: Safeera Yasmeen
authors.initials: SY
authors.lastname: Hussainy
authors.forename: Jennifer Lillian
authors.initials: JL
authors.lastname: Marriott
mesh_terms: D004304:Dosage Forms; D006801:Humans; D008508:Medication Errors / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D011785:Quality Assurance, Health Care; D014739:Victoria
chemical_list: D004304:Dosage Forms; D004364:Pharmaceutical Preparations
keywords: Drug administration schedule; Drug packaging; Medication errors; Medication systems; Older adults