A new five-step process has simplified medication regimens for two-thirds of aged care residents across eight facilities, a Monash University study published this month found.

The SImplification of Medications Prescribed to Long-tErm care Residents’ (SIMPLER) study, funded by the NHMRC Cognitive Decline Partnership Centre, aimed to develop a structured process to consolidate the number of medication administration times for residents.

It did not involve discontinuing any medications or changing the therapeutic intent.

The collaborative research led by Monash University’s Centre for Medicine Use and Safety was published in the Journal of the American Medical Directors Association this month.

The SIMPLER study, which commenced in 2017,  involved 242 residents across eight Helping Hand aged care facilities in South Australia (read more here).

Researchers used the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) tool, which is a five step judgment-based process for pharmacists to assess residents’ medications and identify opportunities to reduce complexities.

Using the tool, the study identified that medication simplification was possible for two-thirds of the residents, said senior researcher of the project Professor Simon Bell.

 “Medication simplification was possible for 62 residents (65 per cent) in the intervention arm, with 57 (62 per cent) of 92 simplification recommendations implemented at follow-up,” Professor Bell told Australian Ageing Agenda.

Professor Simon Bell

There was a significant reduction in the number of medication administration times at the four-month follow-up, which was also sustained at the eight and 12-month follow-up, said Professor Bell, director of Monash University’s Centre for Medicine Use and Safety.

Professor Bell said they simplified regimens through strategies such as taking medications at the same time each day.

“We also identified opportunities for using long-acting formulations,” he said.

Professor Bell said the tool is particularly beneficial for residents who can be taking  five or more medications a day.

“From a resident’s perspective, having a complex medication regimen is of particular burden and so if we can reduce the burden of medication taking, I think that’s a very good resident outcome.

“We also know that having a complex medication regimen is also associated with a higher likelihood of medication errors and medication incidents so if we can reduce the complexity of the medication regimen, then there is a possibility we can reduce the number of medication errors that occur,” Professor Bell said.

Simpler regimens can also save nursing staff time, which can be spent on  other care activities.

“The benefit is also for the aged care provider, particularly with time and reduced likelihood of error,” Professor Bell said.

The MRS GRACE tool involves a pharmacist asking the following questions:

  1. Is there a resident-related factor that precludes simplification?
  2. Is there a regulatory or safety imperative that precludes simplification?
  3. Is simplification likely to result in any clinically significant drug-drug, drug-food or drug-time interactions?
  4. Is there no alternative formulation that can support less complex dosing?
  5. Is simplification likely to result in any unintended consequences?

The study was managed by Monash University researcher Dr Janet Sluggett in partnership with Helping Hand Aged Care.

It involved a team of researchers from Monash University, University of Sydney, University of Queensland, Drug and Therapeutics Information Service in South Australia, and consumer and carer input from Dementia Australia.

Access the research study here.

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