MAC education, quality improvement lacking
Medication advisory committees play a crucial role in managing medication safety, but there are domains that require targeted support, says Dr Amanda Cross.
A national audit on medication use in residential aged care, involving over 100 medication advisory committees – multidisciplinary committees that provide governance of medication management – across almost 650 aged care homes has found wide variation in their structure and function.
Researchers from the Centre for Medicine Use and Safety within Monash University’s Institute of Pharmaceutical Sciences led the audit, examining the functions of 120 MACs across 642 aged care homes in relation to their four recommended operational domains – policy development, risk management, education and quality improvement.
Most of the participant MACs were from non-metropolitan regions – 65 per cent – and 39 per cent were from either independent not-for-profit or private residential aged care provider organisations. There were also MACs that oversaw community services, hospitals and disability support services included – 13 per cent, 5 per cent and 4 per cent respectively.
The presence of MACs in residential aged care has been identified as a key intervention necessary for managing polypharmacy and promoting medication safety.
Lead author and CMUS research fellow Dr Amanda Cross said it was “really promising” that more than half of MACs were multidisciplinary, and were meeting at least every three months.
However, only 41 per cent of surveyed MACs reported that they performed all functions in the Department of Health, Disability and Ageing’s MAC Audit Tool related to education and just 28 per cent reported performing all functions related to quality improvement.
“I think education and quality improvement need to be included on the MAC meeting agenda to ensure they remain a key focus,” Dr Cross told Australian Ageing Agenda.
“This may involve inviting representatives from education or quality improvement teams to provide relevant updates, or appointing dedicated champions to relay ongoing discussions back to the appropriate committees and support implementation of agreed actions. Additionally, MACs should consider how they can best use their data to identify areas for quality improvement, and implement and monitor quality improvement initiatives.”
MACs stronger on policy and risk oversight
But the findings also showed that MACs are involved in policy and risk oversight – with 59 and 53 per cent respectively performing all recommended functions – with further opportunities for capacity building and long-term improvement and more than half performing all functions relating to policy development – 59 per cent – and risk management – 53 per cent.
“Policy endorsement and risk management are commonly seen as key roles of the MAC, and are often guided by regulatory frameworks, guidelines or accreditation standards,” Dr Cross explained to AAA.
“They possibly have the perception of direct and immediate impact on daily operations, making MAC meetings an ideal forum to engage and update key internal staff and external healthcare professionals, such as general practitioners and pharmacists.
“In contrast, education and quality improvement are sometimes managed by separate individuals or dedicated teams within residential care facilities, particularly in larger organisations. This may explain why fewer MACs are actively involved in all aspects of these two domains. However I think this represents a missed opportunity. The MAC should consider how it can contribute meaningfully to education and quality improvement, leveraging their multidisciplinary insights and day-to-day knowledge of the residents and the residential care facility.”
She said the audit highlighted the strengths of MACs in managing medication safety in aged care, but also showed areas needing targeted support, adding that MACs have the potential to lead transformational change in the aged care sector if adequately supported and resourced. They are also well positioned to support the implementation and monitoring of the new strengthened Aged Care Quality Standards – particularly standard 5, relating to the delivery of safe and quality clinical care, she said.
The MAC audit is part of the Maximising Embedded Pharmacists in aGed cAre Medication Advisory Committees – or MEGA-MAC – project, funded by the Medical Research Future Fund.
The complete research findings were published in the Australasian Journal on Ageing and can be found here.
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