Admin, management issues behind medication complaints

The majority of complaints about medications in residential aged care are about receiving medications late or not at all, and poor management systems, research by the Aged Care Quality and Safety Commission and University of Tasmania has found.

“It is important to appreciate that most of the medication-related complaint issues identified in this study relate to basic administration and management of medicines; they do not relate to more complex aspects of pharmaceutical care, such as drug interactions or adverse effects of medicine,” write the authors of the study.

The study – which characterised the areas of medication management most frequently complained about in Australian residential aged care services from 1 July 2019 to 30 June 2020 – identified and analysed 1,134 complaints.

It is the first known study to examine complaints made about medication in residential aged care in depth and comes in response to its high prevalence.

Medication issues – which account about for about 7 per cent of all complaints received by the commission – have consistently been among the issues most complained about in residential aged care, co-author Dr Juanita Breen told Australian Ageing Agenda.

“We wanted to listen to the complainants and learn from the data to find out what matters to consumers, relatives, and staff who lodged these types of complaints,” said Dr Breen, an associate professor at UTAS.

Dr Breen, who also does work for the commission’s clinical pharmacy unit, co-authored the research with ACQSC chief clinical advisor Dr Melanie Wroth and Kathleen Williams from the commission’s clinical pharmacy unit.

Of the 1,134 complaint issues analysed, the study found 45 per cent related to medicine administration processes – the six rights of administration.

“The complaints were predominantly about receiving medications late or not at all, and about poor systems, procedures and policies around medication management. The third most common reason was about the use of medicines to manage residents’ behaviour, or chemical restraint,” Dr Breen told AAA.

In fact, nearly two-thirds of the complaints related to these three categories with the first two accounting for more than half, according to the paper published in the journal Pharmacy.

“The most medication-related complaints were about pain management and palliative care, followed by the use of medicines for sedation in people with dementia and then medicines for urinary tract infections. Opiates were the top mentioned medication group followed by psychotropic medication more generally,” said Dr Breen.

Advice for aged care homes

There are many ways that aged care homes and providers can respond to these findings, said Dr Breen, starting with making sure that residents receive their medications on time and giving prirorty to any that are time sensitive.

“It is important to ensure that your consumers get their medications on time; however, painkillers, Parkinson’s medication, antibiotics and diabetes medication must be prioritised, as the consequences of delayed administration of these medicines can be severe,” Dr Breen said.

“Ask your pharmacist if there are any other medicines which your consumers are taking which are time sensitive. However late administration of medications can be distressing to consumers even if they are not time sensitive.”

Homes should also focus on communication with the Medication Advisory Committee, internal complaints resolution processes and supporting residents who wish to self-administer their medicines, Dr Breen said.

“It’s also important to raise issues about systems, procedures and policies regarding medication to the Medication Advisory Committee and work to ensure optimal management of medications.

“Receiving, responding to and resolving medication-related concerns and complaints internally should be occurring, and where policies and procedures need changing or staff need specific education or support then this should be happening as a normal continuous quality improvement process.

“Many consumers are capable of self-administration and wish to continue to manage their own medication as they always have done. This can be implemented and supported safely and occurs successfully in many services.”

Involve consumers and substitute decision-makers

Dr Breen said a further complaint issue raised was that family members were not always told about new medication their relative was started on, particularly sedating medications. This is particularly important where it involves the consumer’s legal substitute decision-maker and denies them a proper process to give fully informed consent, she said.

“Providers may assume that the prescriber has talked to consumers and their families about medication changes, but it is important to ensure that all consumers, including those who lack capacity, or their substitute decision-makers, are involved in decisions about medications.

“As important partners in care, substitute decision-makers can provide a consumer’s medication history and other important information to the prescriber so that the most appropriate medication can be prescribed, monitored and reviewed.”

Comment on the story below. Follow Australian Ageing Agenda on LinkedIn, X (Twitter) and Facebook, sign up to our twice-weekly newsletter and subscribe to our premium content or AAA magazine for the complete aged care picture.