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Medication supply to residential aged care facilities in Western Australia using a centralized medication chart to replace prescriptions
BMC Geriatrics
Medication supply to residential aged care facilities in Western Australia using a centralized medication chart to replace prescriptions
Kreshnik Hoti 0
Jeffery Hughes 0
Bruce Sunderland 0
0 Equal contributors Curtin Health and Innovation Research Institute, School of Pharmacy, Curtin University , GPO Box U1987, Perth, WA , Australia 6845
Background: Current model of medication supply to Residential Aged Care Facilities (RACFs) in Australia is dependent on paper-based prescriptions. This study is aimed at assessing the use of a centralized medication chart as a prescription-less model for supplying medications to RACFs. Methods: Two separate focus groups were conducted with general practitioners (GPs) and pharmacists, and another three with registered nurses (RNs) and carers combined. All focus group participants were working with RACFs. Audio-recorded data were compared with field notes, transcribed and imported into NVivoW where it was thematically analyzed. Results: A prescription-less medication chart model was supported and it appeared to potentially improve medication supply to RACF residents. Centralization of medication supply, clarification of medication orders and responding in real-time to therapy changes made by GPs were reasons for supporting the medication chart model. Pharmacists preferred an electronic version of this model. All health professionals cautioned against the need for GPs regularly reviewing the medication chart and proposed a time interval of four to six months for this review to occur. Therapy changes during weekends appeared a potential difficulty for RNs and carers whereas pharmacists cautioned about legible writing and claiming of medications dispensed according to a paper-based model. GPs cautioned on the need to monitor the amount of medications dispensed by the pharmacy. Conclusion: The current use of paper prescriptions in nursing homes was identified as burdensome. A prescription-less medication chart model was suggested to potentially improve medication supply to RACF residents. An electronic version of this model could address main potential difficulties raised.
Aged care; Nursing homes; Elderly; Medication chart; Medication supply; Prescriptions
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Background
A significant number of Australias elderly population
are currently cared for in Residential Aged Care
Facilities (RACFs) and represent a population group with a
high prevalence of diseases and co-morbidities [1].
Medication supply in Australian RACFs is currently
negotiated between a community pharmacy and the
RACF. The pharmacy supplies medications based on
general practitioner (GP) paper prescription forms which
are also reproduced by prescribers on individual
residents medication charts. This gives rise to a
requirement for duplicated entries. In order to ensure quality
use of medicines, the use of medication charts to record
administered medicines is one of the recommendations
made by the Australian Pharmaceutical Advisory
Committee [2]. In Australian RACFs, medications are
primarily prescribed by residents GPs. In addition some are
prescribed by specialists, locums and hospital doctors.
Registered Nurses (RN) are allowed to use their clinical
judgment and assessment to initiate Pharmacy Only
and Pharmacist Only medications for RACF residents.
Dentists, optometrists and registered RN practitioners
are also able to prescribe medicines in Australia [3].
Pharmacists are mainly reimbursed for dispensing
and supplying medicines to RACFs through the
Pharmaceutical Benefits Scheme (PBS). This does not
apply for private prescriptions (i.e. medications not
subsidized by the PBS), which are charged to patients. For
reimbursement by the PBS, pharmacists currently need
a paper prescription form for every medication
dispensed, in accordance with the orders on the residents
medication chart. The pharmacy then supplies
medications to RACF residents, usually using Dose
Administration Aids (DAA) or original packs depending on
residents ability to administer medications or by
arrangement with the RACF [1,4]. There may be
situations where residents original prescriptions are not
available for dispensing or repeat prescriptions run out.
In these cases pharmacists are able to initiate or
continue medication supply based on an owing
prescription system but the prescription must be received
within seven days [5]. The owing prescription system
presents a number of important issues, notably
considerable pharmacist time is consumed in following up
prescriptions from GPs and delays in reimbursement whilst
waiting for the prescription to be received from the GP.
[5,6] Furthermore, in some cases GPs may then decide
to discontinue the therapy hence leaving pharmacists
without a prescription [6]. Delays in receiving
prescriptions often renders the owing prescription system in
breach of the statutory requirements. Pharmacists can
also supply medications based on the emergency supply
system. However, this system is ass (...truncated)