scholarly journals Medication administration process in a residential aged care home: An observational study

2018 ◽  
Vol 26 (8) ◽  
pp. 1033-1043 ◽  
Author(s):  
Siyu Qian ◽  
Ping Yu ◽  
David Hailey ◽  
Ning Wang ◽  
Anol Bhattacherjee
Keyword(s):  
Observational Study ◽  
Care Home ◽  
Medication Administration ◽  
Aged Care ◽  
Residential Aged Care

scholarly journals Nursing staff work patterns in a residential aged care home: a time–motion study

2016 ◽  
Vol 40 (5) ◽  
pp. 544 ◽  
Author(s):  
Siyu Qian ◽  
Ping Yu ◽  
David Hailey
Keyword(s):  
Nursing Care ◽  
Nursing Staff ◽  
Care Home ◽  
Medication Administration ◽  
Aged Care ◽  
Verbal Communication ◽  
Residential Aged Care ◽  
Work Patterns ◽  
Time Motion ◽  
Motion Study

Objective Residential aged care services are challenged by an increasing number of residents and a shortage of nursing staff. Developing strategies to overcome this challenge requires an understanding of nursing staff work patterns. The aim of the present study was to investigate the work processes followed by nursing staff and how nursing time is allocated in a residential aged care home. Methods An observational time–motion study was conducted at two aged care units for 12 morning shifts. Seven nurses were observed, one per shift. Results In all, there were 91 h of observation. The results showed that there was a common work process followed by all nurse participants. Medication administration, documentation and verbal communication were the most time-consuming activities and were conducted most frequently. No significant difference between the two units was found in any category of activities. The average duration of most activities was less than 1 min. There was no difference in time utilisation between the endorsed enrolled nurses and the personal carers in providing nursing care. Conclusion Medication administration, documentation and verbal communication were the major tasks in morning shifts in a residential aged care home. Future research can investigate how verbal communication supports nursing care. What is known about the topic? The aging population will substantially increase the demand for residential aged care services. There is a lack of research on nurses’ work patterns in residential aged care homes. What does this paper add? The present study provides a comprehensive understanding of nurses’ work patterns in a residential aged care home. There is a common work process followed by nurses in providing nursing care. Medication administration, verbal communication and documentation are the most time-consuming activities and they are frequently conducted in the same period of time. Wound care, physical review and documentation on desktop computers are arranged flexibly by the nurses. What are the implications for practitioners? When developing a task reallocation strategy to improve work efficiency, effort can be put into tasks that can be arranged more flexibly.

scholarly journals Medication omission rates in New Zealand Residential Aged Care Homes: a national description

2020 ◽  
Author(s):  
Stephanie M Garratt ◽  
Ngaire M Kerse ◽  
Kathryn Peri ◽  
Monique F Jonas
Keyword(s):  
New Zealand ◽  
Clinical Decision Making ◽  
Home Ownership ◽  
Medication Administration ◽  
Aged Care ◽  
Care Staff ◽  
Residential Aged Care ◽  
Level Of Care ◽  
Ownership Type ◽  
Level Data

Abstract Background A medication omission is an event where a prescribed medication is not taken before the next scheduled dose. Medication omissions are typically classed as errors within Residential Aged Care (RAC) homes, as they have the potential to lead to harm if poorly managed, but may also stem from good clinical decision-making. This study aimed to quantify the incidence, prevalence, and types of medication omissions in RAC homes on a national scale, using a New Zealand-based sample. Methods We conducted retrospective pharmacoepidemiology of de-identified medication administration e-records from December 1st 2016 to December 31st 2017. Four tiers of de-identified data were collected: RAC home level data (ownership, levels of care), care staff level data (competency level/role), resident data (gender, age, level of care), and medication related data (omissions, categories of omissions, recorded reasons for omission). Data were analysed using SPSS version 24 and Microsoft Excel.Results A total of 11, 015 residents from 374 RAC homes had active medication charts; 8,020 resided in care over the entire sample timeframe. A mean rate of 3.59 medication doses were omitted per 100 (±7.43) dispensed doses/resident. Seventy-three percent of residents had at least one dose omission. The most common omission category used was ‘not-administered’ (49.9%), followed by ‘refused’ (34.6%). The relationship between ownership type and mean rate of omission was significant (p=0.002), corporate operated RAC homes had a slightly higher mean (3.73 versus 3.33), with greater variation. The most commonly omitted medications were Analgesics and Laxatives. Forty-eight percent of all dose omissions were recorded without a comment justifying the omission. Conclusions This unique study is the first to report rate of medication omissions per RAC resident over a one-year timeframe. Although the proportion of medications omitted reported in this study is less than previously reported by hospital-based studies, there is a significant relationship between a resident’s level of care, RAC home ownership types, and the rate of omission.

scholarly journals Design Challenges for Electronic Medication Administration Record Systems in Residential Aged Care Facilities

2014 ◽  
Vol 05 (04) ◽  
pp. 971-987 ◽  
Author(s):  
E. Lehnbom ◽  
K. Oliver ◽  
A. Georgiou ◽  
C. Rowe ◽  
T. Osmond ◽  
...  
Keyword(s):  
Decision Support ◽  
Medication Administration ◽  
Aged Care ◽  
Residential Aged Care ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Design Challenges ◽  
Roll Out ◽  
Electronic Medication Administration

SummaryIntroduction: Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements.Methods: A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system.Results: The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues.We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows.Discussion: Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.Citation: Tariq A, Lehnbom E, Oliver K, Georgiou A, Rowe C, Osmond T, Westbrook J. Design challenges for electronic medication administration record systems in residential aged care facilities: a formative evaluation. Appl Clin Inf 2014; 5: 971–987http://dx.doi.org/10.4338/ACI-2014-08-RA-0062

scholarly journals Woven Narratives: A Craft Encounter with Tapestry Weaving in a Residential Aged Care Facility

2019 ◽  
Vol 4 (1) ◽  
pp. 256-286
Author(s):  
Ilona Pappne Demecs ◽  
Evonne Miller
Keyword(s):  
Care Home ◽  
Care Facility ◽  
Aged Care ◽  
Residential Aged Care ◽  
Arts Based Research ◽  
Participatory Art ◽  
Qualitative Approaches ◽  
Residential Aged Care Facility ◽  
The Impact

For six months, a tapestry artist/researcher moved her studio into an aged care home to conduct a participatory art project. Drawing on ethnographic-based qualitative approaches, narrative inquiry and researcher-generated photographs, this arts-based research textually and visually documents the impact of introducing the studio-based craft activity of participatory tapestry weaving into an aged care environment. As well as highlighting the joy of creative collaboration and of learning a new skill, this project explores how tapestry weaving facilitated the understanding of the participants’ worlds through stories and reminiscence. This paper also disseminates that craft, as a practice and method, connects materials, ideas and people through engagement, and facilitates wellbeing. Given rapid population ageing, and the fear and stigma surrounding aged care homes, this paper argues that craft practice might help demystify and connect aged care with the broader community, as well as enhancing residents’ quality of life.

Rates of PRN Medication Administration in Australian Residential Aged Care

2021 ◽  
Vol 22 (1) ◽  
pp. 117-123.e1 ◽  
Author(s):  
Leonie Picton ◽  
Jenni Ilomäki ◽  
Claire S. Keen ◽  
Samanta Lalic ◽  
Beverly Adams ◽  
...  
Keyword(s):  
Medication Administration ◽  
Aged Care ◽  
Residential Aged Care

Contextual factors influencing talk in Australian residential aged care

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Madalyn Anne Scerri ◽  
Rajka Presbury
Keyword(s):  
Home Environment ◽  
Care Delivery ◽  
Contextual Factors ◽  
Care Home ◽  
Strong Relationship ◽  
Aged Care ◽  
Individual Characteristics ◽  
Residential Aged Care ◽  
Case Study Methodology ◽  
Content Type

PurposeThis paper offers an exploration of contextual factors that influence carer-to-resident talk in Australian residential aged care.Design/methodology/approachA qualitative exploratory multiple case study methodology and a theoretical framework of service language were applied to explore the perspectives of 21 registered nurses, assistants in nursing, leisure and lifestyle officers, general managers and care managers at three residential aged care homes in Australia.FindingsThe findings demonstrate contextual factors related to the care home environment, the carer and the relationship between carers and residents that impede or enable carer-to-resident talk in residential aged care. Multiple factors related to the care home environment were found to impede carer-to-resident talk, including time pressures, staffing levels, team culture and the prioritisation of tasks. Factors related to carers had potential to either impede or enable talk, including carers' awareness of the importance of communication, level of experience and individual characteristics, values and attitudes. A strong relationship between a carer and resident built on knowledge of individuals was a key enabling factor.Originality/valueThe paper advances an understanding of factors that influence talk and interaction in residential aged care in Australia from carers' and care home leaders' perspectives. The findings can be used to support verbal communication management strategies aligned with a person-centred care approach, including training and development of staff, cultural change interventions and a review of care delivery procedures.

Evaluation of a hybrid paper–electronic medication management system at a residential aged care facility

2016 ◽  
Vol 40 (3) ◽  
pp. 244 ◽  
Author(s):  
Rohan A. Elliott ◽  
Cik Yin Lee ◽  
Safeera Y. Hussainy
Keyword(s):  
Medication Management ◽  
Care Facility ◽  
Medication Administration ◽  
Aged Care ◽  
Management Systems ◽  
Residential Aged Care ◽  
Dose Administration ◽  
Medication Administration Errors ◽  
Residential Aged Care Facility ◽  
Electronic Medication Administration

Objectives The aims of the study were to investigate discrepancies between general practitioners’ paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper–electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5–12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18 min to 98 h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper–electronic medication management systems, in which prescribers’ orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care facilities. The accuracy and safety of these systems has not been studied. What does this paper add? The present study identified discrepancies between general practitioners’ orders and pharmacy-prepared electronic medication administration charts, back-up paper medication charts and dose-administration aids, as well as delays between ordering, charting and administering medicines. Discrepancies and delays sometimes led to medication administration errors. What are the implications for practitioners? Facilities that use hybrid systems need to implement robust systems for communicating medication changes to their pharmacy and reconciling prescribers’ orders against pharmacy-generated medication charts and dose-administration aids. Fully integrated, paperless medication management systems, in which prescribers’ electronic medication orders directly populate an electronic medication administration chart and are automatically communicated to the facility’s pharmacy, could improve patient safety.

scholarly journals Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial

2020 ◽  
Vol 9 (4) ◽  
pp. 1053 ◽  
Author(s):  
Janet K. Sluggett ◽  
Ria E. Hopkins ◽  
Esa YH Chen ◽  
Jenni Ilomäki ◽  
Megan Corlis ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Medication Administration ◽  
Aged Care ◽  
Residential Aged Care ◽  
Medication Regimen ◽  
Term Care ◽  
Randomized Controlled ◽  
The Impact

In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we evaluated the impact of structured medication regimen simplification on medication administration times, falls, hospitalization, and mortality at 8 residential aged care facilities (RACFs) at 12 month follow up. In total, 242 residents taking ≥1 medication regularly were included. Opportunities for simplification among participants at 4 RACFs were identified using the validated Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE). Simplification was possible for 62 of 99 residents in the intervention arm. Significant reductions in the mean number of daily medication administration times were observed at 8 months (−0.38, 95% confidence intervals (CI) −0.69 to −0.07) and 12 months (−0.47, 95%CI −0.84 to −0.09) in the intervention compared to the comparison arm. A higher incidence of falls was observed in the intervention arm (incidence rate ratio (IRR) 2.20, 95%CI 1.33 to 3.63) over 12-months, which was primarily driven by a high falls rate in one intervention RACF and a simultaneous decrease in comparison RACFs. No significant differences in hospitalizations (IRR 1.78, 95%CI 0.57–5.53) or mortality (relative risk 0.81, 95%CI 0.48–1.38) over 12 months were observed. Medication simplification achieves sustained reductions in medication administration times and should be implemented using a structured resident-centered approach that incorporates clinical judgement.

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