Janet K Sluggett1, Esa Y H Chen2, Jenni Ilomäki3, Megan Corlis4, Jan Van Emden4, Michelle Hogan4, Tessa Caporale5, Claire Keen6, Ria Hopkins6, Choon Ean Ooi2, Sarah N Hilmer7, Georgina A Hughes6, Andrew Luu6, Kim-Huong Nguyen8, Tracy Comans8, Susan Edwards9, Lyntara Quirke10, Allan Patching11, J Simon Bell12. 1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia. Electronic address: janet.sluggett@monash.edu. 2. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia. 3. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 4. NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Helping Hand Aged Care, North Adelaide, South Australia, Australia. 5. Helping Hand Aged Care, North Adelaide, South Australia, Australia. 6. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia. 7. NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia. 8. NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Centre for Health Services Research, The University of Queensland, Woolloogabba, Queensland, Australia. 9. Drug & Therapeutics Information Service, GP Plus Marion, South Australia, Australia. 10. Consumer Representative, Dementia Australia, Scullin, Australian Capital Territory, Australia. 11. Helping Hand Consumer and Carer Reference Group, Helping Hand Aged Care, North Adelaide, South Australia, Australia. 12. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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.
RCT Entities:
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.
Authors: Janet K Sluggett; Choon Ean Ooi; Stephanie Gibson; Manya T Angley; Megan Corlis; Michelle E Hogan; Tessa Caporale; Georgina A Hughes; Jan Van Emden; J Simon Bell Journal: Clin Interv Aging Date: 2020-06-02 Impact factor: 4.458
Authors: Janet K Sluggett; Ria E Hopkins; Esa Yh Chen; Jenni Ilomäki; Megan Corlis; Jan Van Emden; Michelle Hogan; Tessa Caporale; Choon Ean Ooi; Sarah N Hilmer; J Simon Bell Journal: J Clin Med Date: 2020-04-08 Impact factor: 4.241
Authors: Janet K Sluggett; Georgina A Hughes; Choon Ean Ooi; Esa Y H Chen; Megan Corlis; Michelle E Hogan; Tessa Caporale; Jan Van Emden; J Simon Bell Journal: Int J Environ Res Public Health Date: 2021-05-27 Impact factor: 3.390
Authors: Nicolas Dugré; J Simon Bell; Ria E Hopkins; Jenni Ilomäki; Esa Y H Chen; Megan Corlis; Jan Van Emden; Michelle Hogan; Janet K Sluggett Journal: J Clin Med Date: 2021-03-06 Impact factor: 4.241