Medication Harm

The extent of medication-related harm to older Australians is well known to Ward MM and LASA, with over 250,000 hospitalisations each year at a cost of $1.4 billion (1). It has been estimated that 50% of this harm is preventable (1).

The recent Royal Commission into Aged Care Quality and Safety Interim Report shone a spotlight on the extent of medication-related harm in aged care homes with respect to chemical restraint (the use antipsychotics and sedatives to restrain residents). The Royal Commission called for urgent action to respond to the overreliance on chemical restraint in aged care (2).

Advocacy

For over six months, Ward MM together with LASA and other key partners (e.g. Pharmaceutical Society of Australia) advocated for changes to the 20-year old government funded medication management program. This outdated program provided medication reviews every 2 years for aged care residents and minimal Quality Use of Medicines (QUM) support for aged care providers. In order to eliminate medication-related harm, we advocated for the following key enhancements (3):

  • Ensuring there is a patient-centric complete cycle of care with follow up reviews.
  • Improving access to the RMMR program by expanding the pool of specialists, in addition to GPs, who can refer for an initial review.
  • Ensuring provision of a high-quality service through optimal use of the accredited clinical pharmacist pool and peer review.
  • More funding for increased ‘time on ground’ for Clinical Pharmacists to support aged care providers to undertake QUM activities such as chemical restraint audits and antimicrobial stewardship.

In response to the Royal Commission’s interim report and key stakeholder lobbying, the Government announced increased funding and changes to the medication management programs. These changes align very closely with initial our recommendations (4).

  1. Aged care residents can now access three medication reviews within a nine-month period. This will allow for clinical pharmacists to work with residents, prescribers and families to ensure medicines are used optimally and to minimise side effects.
  2. General Practitioners along with other specialists can now refer for a medication review.
  3. Accredited clinical pharmacists must undertake the initial review and provide high-quality reports to the referring practitioners based on industry guidelines.
  4. Increased funding to the QUM program will allow clinical pharmacists to spend more time at aged care facilities to undertake educational and audit activities.

Telehealth

In addition to the above changes to the medication management program and in response to COVID-19, the government will now fund medication reviews by Telehealth. LASA was instrumental in advocating for this service to ensure residents would not be exposed to medication-related harm during the COVID-19 pandemic.

Moving Forward

We hope these changes are a foundation on which to build ongoing support for medication management services in aged care, recognising the significant contribution clinical pharmacists make to medication safety. In the future, services could be enhanced by funding clinical pharmacists to take part in collaborative case conferencing with prescribers.

In our submission to the Royal Commission we also advocated for: ‘Harnessing data to encourage accountability and inform policy’ and ‘Investing in funding for research in aged care’. These are yet to be specifically addressed. In order to ensure the program changes effectively impact older Australian’s lives and support aged care providers in meaningful ways, funding for data linkage and research is imperative.

If you need any assistance or advice on the appropriate use of medications in aged care, including these changes, please contact Ward Medication Management (1800 927 366) or LASA on 1300 111 636.

References:

  1. Pharmaceutical Society of Australia 2019. Medicine Safety: Take Care. Canberra: PSA.
  2. Aged Care in Australia: A Shocking Tale of Neglect [press release]. Canberra, Australia.2019.
  3. Hillen JB, Soulsby N, Rhody-Nicoll F, Cussens C. Medication Quality and Safety in Aged Care. Submission to the Royal Commission into Aged Care Quality and Safety. Enhanced Models of Care. Meeting Community Expectations.: Ward Medication Management; 2019.
  4. Pharmacy Programs Administrator. Residential Medication Management Review and Quality Use of Medicines. 2020 available from: https://www.ppaonline.com.au/programs/medication-management-programs/residential-medication-management-review-and-quality-use-of-medicines.

Authors:
Ms Fiona Rhody-Nicoll (CEO, Ward Medication Management)
Dr Jodie Hillen (Senior Research Analyst, Ward Medication Management)