Medication administration issues in residential aged care – four cases

Multiple morbidities with concomitant use of multiple medications are common in the elderly and the challenges of polypharmacy are recognized. An audit was undertaken over a 4 week period to identify any administration issues related to medications taken by residents at three aged care facilities. Polypharmacy was common amongst the 313 residents (90.1%). The majority of residents were female (73%), with a mean age of 85.8, and administered just over nine individual medications taken regularly (both prescription and over-the-counter). Of these, three administration issues were identified for four residents: off-label drug use; exceeding maximum daily doses by supplementary medications PRN (“as required”); and modification of dosage form (two residents). Nursing staff were advised of concerns and given suggestions for alternative approaches regarding the lack of evidence of efficacy of topical antimicrobials for chronic venous leg ulcers, the combination of two different paracetamol formulations resulting in a daily dose 990 mg greater than recommended (4 grams), and the inappropriateness of crushing controlled release medications. To the credit of busy staff in a challenging care environment, the percentage of administration related issues identified was very low (less than 1%). However, investigation of other potential medication-related issues including drug doses, dosing frequency, indication for use, and drug interactions were outside the limited scope of this study. These findings highlight the significant role pharmacists can play in identifying medications for which rationality of use is questionable. They also highlight the need for ongoing education of all health practitioners on a range of medication issues.