Abstract
Objective
To assess the application of a structured process to consolidate the number of medication
administration times for residents of aged care facilities.
Design
A nonblinded, matched-pair, cluster randomized controlled trial.
Setting and Participants
Permanent residents who were English-speaking and taking at least 1 regular medication,
recruited from 8 South Australian residential aged care facilities (RACFs).
Methods
The intervention involved a clinical pharmacist applying a validated 5-step tool to
identify opportunities to reduce medication complexity (eg, by administering medications
at the same time or through use of longer-acting or combination formulations). Residents
in the comparison group received routine care. The primary outcome at 4-month follow-up
was the number of administration times per day for medications charted regularly.
Resident satisfaction and quality of life were secondary outcomes. Harms included
falls, medication incidents, hospitalizations, and mortality. The association between
the intervention and primary outcome was estimated using linear mixed models.
Results
Overall, 99 residents participated in the intervention arm and 143 in the comparison
arm. At baseline, the mean resident age was 86 years, 74% were female, and medications
were taken an average of 4 times daily. Medication simplification was possible for
62 (65%) residents in the intervention arm, with 57 (62%) of 92 simplification recommendations
implemented at follow-up. The mean number of administration times at follow-up was
reduced in the intervention arm in comparison to usual care (−0.36, 95% confidence
interval −0.63 to −0.09, P = .01). No significant changes in secondary outcomes or harms were observed.
Conclusions and Implications
One-off application of a structured tool to reduce regimen complexity is a low-risk
intervention to reduce the burden of medication administration in RACFs and may enable
staff to shift time to other resident care activities.
Keywords
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Article info
Publication history
Published online: March 13, 2020
Footnotes
This work was supported by the National Health and Medical Research Council (NHMRC) Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People (Cognitive Decline Partnership Centre or CDPC) (grant number GNT9100000). The CDPC receives support from the NHMRC and funding partners including Helping Hand Aged Care, HammondCare, Brightwater, and Dementia Australia. The contents of the published materials are solely the responsibility of the individual authors identified and do not reflect the views of the NHMRC and any other funding bodies or the funding partners. J.K.S. is supported by an NHMRC Early Career Fellowship (grant number APP1156439). J.S.B. and T.Co. are supported by NHMRC Boosting Dementia Research Fellowships. E.Y.H.C. was supported by a postgraduate research scholarship funded by the NHMRC CDPC and the Monash University Faculty of Pharmacy and Pharmaceutical Sciences. A.L. and G.A.H. were supported by summer vacation research scholarships funded by NHMRC CDPC and the Monash University Faculty of Pharmacy and Pharmaceutical Sciences.
M.C., J.V.E., M.H., and T.C. are employed by the organization providing residential aged care services to study participants. There are no other conflicts of interest to declare.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
