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National Monitoring of Medication-Related Quality of Care in Residential Aged Care: Is Australia Making Progress?

  • Gillian E. Caughey
    Correspondence
    Address correspondence to Gillian E. Caughey, PhD, Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, South Australia, 5001, Australia.
    Affiliations
    Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
    UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
    Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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  • Janet K. Sluggett
    Affiliations
    Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
    UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
    Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
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  • Catherine Lang
    Affiliations
    Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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  • Steve L. Wesselingh
    Affiliations
    Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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  • Maria C. Inacio
    Affiliations
    Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
    UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Published:August 13, 2022DOI:https://doi.org/10.1016/j.jamda.2022.07.008
      In 2018, the Australian Government established a Royal Commission into Aged Care Quality and Safety.
      Royal Commission into Aged Care Quality and Safety
      Final Report: Care, Dignity and Respect. Volume 1 Summary and Recommendations.
      Recommendations from the final report in 2021 included national monitoring of quality of care in residential aged care facilities (RACFs) and the need to improve medication-related care to reduce medication-related harms and improve resident well-being.
      Royal Commission into Aged Care Quality and Safety
      Final Report: Care, Dignity and Respect. Volume 1 Summary and Recommendations.
      Over the past decade, the health status of those entering RACFs in Australia has worsened, together with increased frailty and polypharmacy.
      • Inacio M.C.
      • Lang C.
      • Bray S.C.E.
      • et al.
      Health status and healthcare trends of individuals accessing Australian aged care programmes over a decade: the Registry of Senior Australians historical cohort.
      Studies have shown that 44% to 73% of RACF residents use 1 or more potentially inappropriate medications, including high-risk medications such as opioids and antipsychotics.
      • Sluggett J.K.
      • Harrison S.L.
      • Ritchie L.A.
      • et al.
      High-risk medication use in older residents of long-term care facilities: prevalence, harms, and strategies to mitigate risks and enhance use.
      ,
      • Pharmaceutical Society of Australia
      Medicine Safety: Aged Care.
      Internationally, many countries mandate the monitoring and reporting of medication-related quality of care in residential long-term care with the aim to drive improvements in quality and care outcomes.
      • Caughey G.E.
      • Lang C.E.
      • Bray S.C.
      • et al.
      International and National Quality and Safety Indicators for Aged Care.
      The Registry of Senior Australians (ROSA) has developed quality indicators to examine the quality and safety of aged care using existing data sources, including 4 medication-related indicators (high sedative load, antipsychotic use, chronic opioid use, and antibiotic use) to monitor medication-related care.
      • Inacio M.C.
      • Lang C.
      • Caughey G.E.
      • et al.
      The Registry of Senior Australians outcome monitoring system: quality and safety indicators for residential aged care.
      Using these indicators, we examined if medication-related quality of care in Australia has changed over the past 5 years, using routinely collected data.
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      References

        • Royal Commission into Aged Care Quality and Safety
        Final Report: Care, Dignity and Respect. Volume 1 Summary and Recommendations.
        (Accessed January 12, 2022.)
        • Inacio M.C.
        • Lang C.
        • Bray S.C.E.
        • et al.
        Health status and healthcare trends of individuals accessing Australian aged care programmes over a decade: the Registry of Senior Australians historical cohort.
        Intern Med J. 2021; 51: 712-724
        • Sluggett J.K.
        • Harrison S.L.
        • Ritchie L.A.
        • et al.
        High-risk medication use in older residents of long-term care facilities: prevalence, harms, and strategies to mitigate risks and enhance use.
        Sr Care Pharm. 2020; 35: 419-433
        • Pharmaceutical Society of Australia
        Medicine Safety: Aged Care.
        Pharmaceutical Society of Australia, Canberra, Australia2020
        • Caughey G.E.
        • Lang C.E.
        • Bray S.C.
        • et al.
        International and National Quality and Safety Indicators for Aged Care.
        in: Research Paper 8. Report for the Royal Commission into Aged Care Quality and Safety. South Australian Health and Medical Research Institute, Adelaide, Australia2020
        • Inacio M.C.
        • Lang C.
        • Caughey G.E.
        • et al.
        The Registry of Senior Australians outcome monitoring system: quality and safety indicators for residential aged care.
        Int J Qual Health Care. 2020; 32: 502-510
        • Gerlach L.B.
        • Fashaw S.
        • Strominger J.
        • et al.
        Trends in antipsychotic prescribing among long-term care residents receiving hospice care.
        J Am Geriatr Soc. 2021; 69: 2152-2162