title: Medication safety in residential aged-care facilities: a perspective.
abstract: Medication safety must be tailored to the distinctive issues in residential aged-care facilities (RACFs). The health and functional characteristics of their residents are different to those of hospital inpatients and community-dwelling older adults, and there are unique staffing and management issues. Understanding the aetiology and epidemiology of drug-related problems is vital in developing methods to improve patient safety. In this perspective review, we discuss tools that are used to quantify exposure to 'high-risk' medications and their evaluation in residential aged-care settings. Drug withdrawal interventions are described as a potential way to reduce adverse drug events in RACFs. Multidisciplinary professional interventions, education programs and improved communication between health professionals have been shown to improve medication safety in RACFs. Technological advances and other administrative strategies may also improve resident safety. This perspective addresses issues in medication safety facing RACFs and methods to improve the safety of medicines for their residents.
authors.affiliation: Kolling Institute of Medical Research, Institute of Bone and Joint Research, Royal North Shore Hospital, St Leonards, NSW 2065 and Sydney Medical School, University of Sydney, Camperdown, NSW 2006, Australia.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Wilson
authors.affiliation: Kolling Institute of Medical Research, Institute of Bone and Joint Research, Royal North Shore Hospital, St Leonards, NSW 2065 and Sydney Medical School, University of Sydney, Camperdown, NSW 2006, Australia.
authors.forename: Lyn M
authors.initials: LM
authors.lastname: March
authors.affiliation: Kolling Institute of Medical Research, Institute of Bone and Joint Research, Royal North Shore Hospital, St Leonards, NSW 2065 and Sydney Medical School, University of Sydney, Camperdown, NSW 2006, Australia.
authors.forename: Philip N
authors.initials: PN
authors.lastname: Sambrook
authors.affiliation: Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
keywords: inappropriate medications; medication safety; nursing home; pharmacist review; residential aged care
references.citation: Stud Health Technol Inform. 2009;146:516-20
references.pmid: 19592897
references.citation: Age Ageing. 2004 Nov;33(6):612-7
references.pmid: 15385274
references.citation: Vnitr Lek. 2008 Dec;54(12):1161-9
references.pmid: 19140525
references.citation: Br J Clin Pharmacol. 2007 Feb;63(2):177-86
references.pmid: 17166186
references.citation: J Am Geriatr Soc. 2009 Feb;57(2):243-50
references.pmid: 19207141
references.citation: Int J Geriatr Psychiatry. 2008 Sep;23(9):889-95
references.pmid: 18306150
references.citation: Am J Med. 2009 Dec;122(12):1142-1149.e1-2
references.pmid: 19958893
references.citation: Arch Intern Med. 1999 Nov 22;159(21):2553-60
references.pmid: 10573045
references.citation: Drugs Aging. 2008;25(6):521-9
references.pmid: 18540690
references.citation: Ann Pharmacother. 2005 Mar;39(3):405-11
references.pmid: 15671088
references.citation: JAMA. 2010 Jan 20;303(3):258-66
references.pmid: 20085954
references.citation: Med Care. 2007 Jan;45(1):95-9
references.pmid: 17279026
references.citation: Am J Geriatr Pharmacother. 2004 Dec;2(4):257-64
references.pmid: 15903284
references.citation: Am J Med. 2000 Aug 1;109(2):87-94
references.pmid: 10967148
references.citation: J Am Med Inform Assoc. 2009 Jul-Aug;16(4):486-92
references.pmid: 19390109
references.citation: Aust Fam Physician. 2005 Apr;34(4):283-7
references.pmid: 15861754
references.citation: J Am Geriatr Soc. 1994 Jan;42(1):33-8
references.pmid: 8277112
references.citation: J Crit Care. 2003 Dec;18(4):201-5
references.pmid: 14691892
references.citation: J Am Geriatr Soc. 2005 Jun;53(6):955-62
references.pmid: 15935017
references.citation: J Clin Pharmacol. 2006 Dec;46(12):1481-6
references.pmid: 17101747
references.citation: Curr Drug Saf. 2010 Jan;5(1):13-8
references.pmid: 20210714
references.citation: Pharmacoepidemiol Drug Saf. 2009 Oct;18(10):916-22
references.pmid: 19585466
references.citation: Drugs Aging. 2009;26(12):1013-28
references.pmid: 19929029
references.citation: Drugs Aging. 2009 Dec;26 Suppl 1:15-30
references.pmid: 20136166
references.citation: Age Ageing. 2008 Mar;37(2):138-41
references.pmid: 18349010
references.citation: Arch Intern Med. 2008 Mar 10;168(5):508-13
references.pmid: 18332297
references.citation: Arch Intern Med. 1991 Sep;151(9):1825-32
references.pmid: 1888249
references.citation: Arch Intern Med. 2005 Jan 10;165(1):68-74
references.pmid: 15642877
references.citation: J Clin Pharmacol. 2011 Feb;51(2):256-63
references.pmid: 20489026
references.citation: Clin Ther. 2009 Sep;31(9):2018-37
references.pmid: 19843492
references.citation: J Clin Nurs. 2008 Oct;17(20):2750-7
references.pmid: 18808644
references.citation: BMC Geriatr. 2004 Oct 15;4:9
references.pmid: 15488143
references.citation: Psychopharmacol Bull. 2002 Autumn;36(4):14-9
references.pmid: 12858139
references.citation: Can J Public Health. 2009 Nov-Dec;100(6):426-31
references.pmid: 20209735
references.citation: Arch Intern Med. 2007 Apr 23;167(8):781-7
references.pmid: 17452540
references.citation: Consult Pharm. 2007 Jul;22(7):586-92
references.pmid: 17714003
references.citation: Am J Geriatr Psychiatry. 2008 Aug;16(8):621-32
references.pmid: 18669940
references.citation: Ann Pharmacother. 2010 Jun;44(6):957-63
references.pmid: 20460558
references.citation: J Am Geriatr Soc. 1999 Jan;47(1):30-9
references.pmid: 9920227
references.citation: Arch Intern Med. 2001 Jul 9;161(13):1629-34
references.pmid: 11434795
references.citation: J Am Geriatr Soc. 2004 Aug;52(8):1349-54
references.pmid: 15271125
references.citation: Pharmacoepidemiol Drug Saf. 2002 Mar;11(2):97-104
references.pmid: 11998544
references.citation: Ann Pharmacother. 2009 Jun;43(6):1096-106
references.pmid: 19470856
references.citation: Am J Geriatr Pharmacother. 2004 Dec;2(4):248-56
references.pmid: 15903283
references.citation: Home Care Provid. 1998 Feb;3(1):20-1, 24
references.pmid: 9644369
references.citation: J Am Geriatr Soc. 2004 Jun;52(6):867-74
references.pmid: 15161448
references.citation: J Am Geriatr Soc. 2007 Sep;55(9):1451-7
references.pmid: 17915344
references.citation: Ann Pharmacother. 2006 Sep;40(9):1522-6
references.pmid: 16882872
references.citation: Nurs Clin North Am. 2009 Jun;44(2):187-95
references.pmid: 19463675
references.citation: Age Ageing. 2010 Jul;39(4):503-7
references.pmid: 20501606
references.citation: J Gerontol. 1994 Mar;49(2):M85-94
references.pmid: 8126356
references.citation: Eur Arch Psychiatry Clin Neurosci. 1990;240(1):28-33
references.pmid: 2147899
references.citation: Arch Gen Psychiatry. 1977 Feb;34(2):236-9
references.pmid: 14603
references.citation: Pharmacotherapy. 2005 Nov;25(11):1592-601
references.pmid: 16232021
references.citation: J Am Geriatr Soc. 1999 Jan;47(1):40-50
references.pmid: 9920228
references.citation: Arch Intern Med. 1997 Oct 13;157(18):2089-96
references.pmid: 9382665
references.citation: Am J Psychiatry. 1992 Oct;149(10):1393-4
references.pmid: 1530077
references.citation: Drugs Aging. 2009;26(8):677-86
references.pmid: 19685933
references.citation: Drugs Aging. 2008;25(12):1021-31
references.pmid: 19021301
references.citation: J Clin Epidemiol. 1992 Oct;45(10):1045-51
references.pmid: 1474400
references.citation: N Z Med J. 1991 Nov 27;104(924):495-7
references.pmid: 1745461
references.citation: Br J Clin Pharmacol. 2009 Dec;68(6):936-47
references.pmid: 20002089
references.citation: J Am Geriatr Soc. 2004 Jun;52(6):861-6
references.pmid: 15161447
references.citation: Ann Pharmacother. 1997 May;31(5):543-8
references.pmid: 9161645
references.citation: Rev Esp Geriatr Gerontol. 2009 Sep-Oct;44(5):273-9
references.pmid: 19540624
references.citation: J Gen Intern Med. 1993 May;8(5):278-83
references.pmid: 8505690
references.citation: Jt Comm J Qual Saf. 2004 Jan;30(1):5-14
references.pmid: 14738031
references.citation: Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83
references.pmid: 18218287
references.citation: Arch Intern Med. 1999 Aug 9-23;159(15):1733-40
references.pmid: 10448776
references.citation: Int J Med Inform. 2010 Apr;79(4):232-42
references.pmid: 20138577
references.citation: Arch Intern Med. 2003 Dec 8-22;163(22):2716-24
references.pmid: 14662625
references.citation: Consult Pharm. 2006 Dec;21(12):981-7
references.pmid: 17243849
references.citation: Drugs Aging. 2007;24(8):691-9
references.pmid: 17702537
references.citation: Clin Pharmacol Ther. 2007 Feb;81(2):235-41
references.pmid: 17192773
references.citation: Int Nurs Rev. 2010 Mar;57(1):98-106
references.pmid: 20487481
references.citation: Br J Clin Pharmacol. 2009 Jul;68(1):97-105
references.pmid: 19660007
references.citation: Lancet. 2005 Nov 26;366(9500):1885-93
references.pmid: 16310556
references.citation: Arch Gen Psychiatry. 2003 Feb;60(2):198-203
references.pmid: 12578438
references.citation: Jt Comm J Qual Patient Saf. 2009 Jan;35(1):29-35
references.pmid: 19213298
references.citation: Semin Clin Neuropsychiatry. 2000 Apr;5(2):149-53
references.pmid: 10837103
references.citation: J Gerontol A Biol Sci Med Sci. 2009 Apr;64(4):492-8
references.pmid: 19196642
references.citation: Lancet. 2000 Oct 7;356(9237):1255-9
references.pmid: 11072960
references.citation: Fundam Clin Pharmacol. 2007 Jun;21(3):217-30
references.pmid: 17521291
references.citation: Br J Clin Pharmacol. 2007 Feb;63(2):232-7
references.pmid: 16939531
references.citation: Clin Pharmacol Ther. 2008 Mar;83(3):422-9
references.pmid: 17713474
references.citation: Scand J Prim Health Care. 2007 Mar;25(1):9-14
references.pmid: 17354153
references.citation: J Am Geriatr Soc. 2005 Aug;53(8):1290-5
references.pmid: 16078953
references.citation: Consult Pharm. 2004 Jun;19(6):533-7
references.pmid: 16553470
references.citation: BMJ. 2008 Apr 26;336(7650):956-7
references.pmid: 18397948
references.citation: Aging Clin Exp Res. 2004 Aug;16(4):270-6
references.pmid: 15575120
references.citation: Arch Intern Med. 2004 Mar 8;164(5):545-50
references.pmid: 15006832
references.citation: J Am Geriatr Soc. 2010 Jan;58(1):44-53
references.pmid: 20002510
references.citation: Drugs Aging. 2010 Mar 1;27(3):239-54
references.pmid: 20210369
references.citation: Int Psychogeriatr. 2001 Mar;13(1):85-91
references.pmid: 11352338
references.citation: J Gerontol Nurs. 2005 Sep;31(9):4-11
references.pmid: 16190007