By Yasmin Noone

A recent Monash University audit of almost 50 Victorian residential aged care facilities has identified five major medication management concerns that could potentially affect the accuracy of blister packs and sachets.

The 2011 medication management audit, part of a research trial currently underway by a Monash University PhD student, found that some medicines, when taken out of their recommended bottle and put into a blister pack or sachet, become potentially unstable.

The results also showed that some medicines were being included in the blister packs even though there was no instruction to do so. Occasionally, the wrong number of medicines was packed; medicines were missing from the pack even though medication charts specified their presence; and some medicines – either in the sachets or blister packs- were significantly damaged by the time they got to the user.

The ongoing trial, A review of dose administration aides: improving medicine management, is being conducted by registered pharmacist and PhD candidate in the Department of Pharmacy Practice at the Monash University Centre for Medicine Use and Safety (CMUS), Julia Gilmartin.

Ms Gilmartin said the audit results prove that facilities should adopt a quality improvement process to improve the accuracy of their medication management aides.

“We undertook the evaluation, not to say which aide is better than the other – each system has its own benefits and different systems suit different facilities,” Ms Gilmartin said.

"Instead, we evaluated both systems to see if each of them could benefit from quality improvement.

“Our results have shown that while both systems may have great advantages for aged care facilities and increase the efficiency of safety administration, they still benefit from regular auditing, evaluation and quality improvement initiatives.

“…Pharmacists and pharmacy staff exercise a great level of care when they prepare these aids to be used in aged care facilities for medicine administration, so it is important to see what problems may occur and to help improve this medicine preparation system.”

Around 49 aged care facilities across Victoria, from rural and remote areas to the inner and outer Melbourne suburbs, were involved in the six-month audit component of the trial.

Ms Gilmartin explained that the next stage of the research, which seeks to evaluate the reasons why the five issues occur and determine how to overcome the problems, is now underway.

A number of focus groups featuring nurses, pharmacy staff, pharmacists, pharmacy technicians, general practitioners and personal carers will inform the trial, providing information and suggestions on what can be done to improve current systems.

“We are looking for people to participate in the focus groups, from the people who are involved in packing the blister packs or sachets to those who administer it."

Focus group participants should be able to attend sessions at the Monash University Pharmacy Campus in Parkville. However, interested people who live outside the area can still be involved. Ms Gilmartin invites them to email her and express their interest.

“We will analyse that information and qualitative data, assisted by computer software, and identify the major themes arising from the focus groups.

“[We will find out] what the major issues are that contribute to packing incidents; what medication management ideas are now being implemented that work; what ideas are there that have not been tried but should work…and what are the barriers or facilitators to improvement?”

Improvement initiatives, which could be implemented in any facility around the country, will then be determined and be followed-up with another medicine audit.

Ms Gilmartin said the flow-on effects from her research could improve dose administration aide provision in Victoria, as well as other Australian states.

“My research aims to improve pharmacy packing of these aides, and aged care staff handling of medicine problems found within them.

“...This is an area that I feel passionate about. This is ‘our’ ageing population…We want to support [older people moving into or living in residential aged care] and support the workforce supporting our ageing population.

“We want to support the nurse, pharmacist, [GP] and personal carer who are involved in this medication management process.

“They all are doing a wonderful job with older Australians living in residential aged care. With quality improvement, further research and our findings, we can create a better working environment for staff involved in medication management in residential aged care, and a better a better living environment for older Australians as well.”

For more information or to register your interest in the focus groups currently underway, email Julia Gilmartin at julia.gilmartin@monash.edu