title: Medicines Management, Medication Errors and Adverse Medication Events in Older People Referred to a Community Nursing Service: A Retrospective Observational Study.
abstract: BACKGROUND
  Increasing numbers of older people are receiving support with medicines management from community nursing services (CNSs) to enable them to live in their own homes. Little is known about these people and the support they receive.
  
  
  OBJECTIVE
  To explore the characteristics of older people referred for medicines management support, type of support provided, medication errors and adverse medication events (AMEs).
  
  
  METHODS
  A retrospective observational study of a random sample of 100 older people referred to a large non-profit CNS for medicines management support over a 3-month period was conducted. Measures were: demographics, referral source, current medical problems, medicines, medication aids, types of medication authorisations used by nurses, frequency of nurse visits and type of support provided, medication errors, AMEs and interdisciplinary teamwork among community nurses, general practitioners and pharmacists.
  
  
  RESULTS
  Older people (median 80 years) were referred for medicines support most often by hospitals (39 %). Other referrals were from families/carers, case-managers, palliative care services and general practitioners. Multiple health conditions (median 5) and medicines (median 10) were common; 66 % used ≥5 medicines; 48 % used ≥1 high-risk medicines-most commonly opiates, anticoagulants and insulin. Medication aids were frequently used, mostly multi-compartment dose administration aids (47 %). Most people received regular community nurse visits (≥4 per week) to administer medicines or monitor medicine-taking. Only 16 % had a medication administration chart; for other clients nurses used medicine lists or letters from doctors for medication authorisation. Medication errors occurred in 41 % of people and 13 % had ≥1 AME requiring medical consultation or hospitalisation; 9/13 (64 %) AMEs were potentially preventable. There was little evidence of interdisciplinary teamwork or medication review.
  
  
  CONCLUSIONS
  CNS clients had multiple risk-factors for medication misadventure. Deficiencies in medicines management were identified, including low use of medication charts and interdisciplinary medication review. Strategies are needed to improve medicines management in the home-care setting.
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia. rohan.elliott@austin.org.au.|Pharmacy Department, Austin Health, P.O. Box 5444, Heidelberg West, VIC, 3081, Australia. rohan.elliott@austin.org.au.
authors.forename: Rohan A
authors.initials: RA
authors.lastname: Elliott
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia.|RDNS Institute, Royal District Nursing Service, 31 Alma Road, St Kilda, VIC, 3182, Australia.
authors.forename: Cik Yin
authors.initials: CY
authors.lastname: Lee
authors.affiliation: RDNS Institute, Royal District Nursing Service, 31 Alma Road, St Kilda, VIC, 3182, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Beanland
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia.
authors.forename: Krishna
authors.initials: K
authors.lastname: Vakil
authors.affiliation: RDNS Institute, Royal District Nursing Service, 31 Alma Road, St Kilda, VIC, 3182, Australia.|Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Commercial Rd, Prahran, VIC, 3004, Australia.
authors.forename: Dianne
authors.initials: D
authors.lastname: Goeman