Major Aged Care Reforms in 2024: What to expect
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Timing of Medication Administration in Aged Care: The ‘Silent’, Unrecorded Incident

3/03/20
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The risks associated with medication incidents are well-recognised, and most aged care providers have systems in place to ensure medication incidents are properly reported. These systems often focus on identifying and reporting where medicine is administered to the wrong consumer or in the wrong dose.

But what about medicine being administered at the wrong time? How many incidents related to the wrong time of medicine administration, particularly with regard to time-critical medicines, are dismissed and not reported?

In this article we’ll look at why it’s important to administer medication at the ‘right’ time, and why it’s important to report any incidents of mis-timed medication administration. We’ll also give you some tips on how to incorporate medication timing into your systems so that you can better protect consumers and ensure ongoing compliance with the Aged Care Quality Standards.

 

Right Time – Why is it Important?

In many cases, it is vital that medication be administered at the right time. This is because:

  • some medications are time-critical and must only be administered at a particular time or at particular intervals to ensure the consumer gets the therapeutic benefit, avoids unpleasant effects and stays safe
  • best practice guidelines, such as “Rights of Safe Medication Administration” require staff to ensure medication is administered at the right time
  • the Aged Care Quality Standards require aged care providers to provide consumers with quality care tailored to their individual needs (Standard 3) as well as choice and control in relation to their own care (Standards 1 and 2).

 

Wrong Time – Why Does it Happen and Why Does it Go Unreported?

Why is medication sometimes administered at the wrong time and why do such incidents sometimes go unreported?

One reason is sheer practicality. Aged care homes are busy places where a small number of staff often have to administer medication to a large number of consumers in a short space of time. In these circumstances it can be practical and efficient to deliver medications according to a general schedule rather than a schedule tailored to the individual needs and preferences of each consumer.

Another reason why some aged care homes are not as concerned as they should be about the timing of medication administration is because the issue is not formally part of the Aged Care Quality and Safety Commission (ACQSC) assessment process. At present, the focus of ACQSC Assessors during the entry meeting is the identification of whether a wrong medication has been given to a consumer in the previous three months. In the ACQSC’s guidance and resources, wrong timing of medication is not listed as a factor that Assessors will consider. As a result, aged care providers who use reactive compliance strategies that merely ‘tick the boxes’ set by the ACQSC, may find that they have a big gap in this area.

 

Right Time – How To Get It Right

So how can you ensure that medication is administered at the right time? A recent article in the Australian Prescriber sets out some useful tips, including:

  • Ensure that you incorporate the prescriber’s documented instructions into your plans for timing of medication administration.
  • Appropriate administration should balance timing with the individual consumer’s preferences and choices and best practice recommendations.
  • Medication information resources (e.g. Australian Medicines Handbook) should be referred to for timing of medicine administration guidance, especially timing related to with or without food.
  • Some consumers may be more compliant if medicine is administered at particular times of day, particularly consumers living with dementia. However, this consideration must always be balanced against medicine information and the advice of the Pharmacist and Medical Practitioner.
  • Time-critical medications should be clearly identified on the consumer’s medication charting, including electronic medication systems (eMM). Administering staff should adhere strictly to the medication timing schedules to ensure no delays in administration. Examples of time-critical medications include those administered for Parkinson’s Disease, diabetes or as part of pain management regimes.
  • Most medication administration times are about the medicine being given at the same time each day. You should also consider whether some medications are better off being taken in the morning or at night so as to maximise their effect and/or to minimise side effects to the consumer. This needs to be reflected in the planning and documenting of medication administration times.
  • Antibiotics administered more than once a day should be spaced as evenly as possible during the consumer’s waking hours. Timing is also essential given that the medications are only to be administered for a specified period and in accordance with the requirements for a specific clinical condition.
  • Where medications may have a potential sedative effect (e.g. some types of antidepressants), these need to be timed for administration at night.
  • The impact of the medication on the consumer’s safety as well as overall well-being must also be considered in the timing of medication administration. This includes administration of diuretics in the morning so as not to interfere with sleep or increase the risk of falls due to increased diuresis.
  • Pain medication administration times need to be planned to ensure safe and effective pain management that maximises the benefits for the consumer’s overall health, well-being, and quality of life.
  • Several medicines are only able to be used for a specific time duration while other medicines, once opened, have a limited use by period or expiry date. Both are part of the ‘right’ time check process and need to be observed and verified to ensure safe medication administration.

 

Right Time – Required Management Systems

Like many aspects of aged care, managing the timing of medication administration is a complex business. To get it done well – and sustainably – you have to take the hard work out of your head and put it into a system of policies and procedures. Here are a few considerations to bear in mind when putting such a system together:

  • Medication policy and procedures should provide clear staff guidance and practice instruction in relation to medication timing, particularly time critical medications, and specific medication expiry dates. This information should be easily accessible to staff who are administering medication.
  • Medication charting systems, both paper-based and eMM systems must advise staff clearly in relation to the timing for prescribed medicine administration. The care plan should specify specific consumer needs, preferences or instructions to ensure uniform administration practices across staff.
  • Where an eMM system is used, reports detailing the actual administration time and the time duration between medicine doses are available. These reports should be used in decision making regarding ongoing safe administration timing (e.g. paracetamol administration).
  • Competency assessment of medication administration staff should include specific areas of practice review in relation to medication timing.
  • Medication training should provide updates in relation to medication timing, as well as specific drug knowledge and understanding for nurses in accordance with their scope of practice.
  • Incident management systems should include and support a culture whereby incidents where the medication was not administered at the ‘right’ time are reported and investigated.
  • Audits should monitor staff adherence to good practices regarding medication administration times. Where gaps are recognised, appropriate corrective actions and system improvements must be implemented.

 

Conclusion

If medication is administered outside of the prescribed administration time, or medication administration does not meet best practice requirements or falls short in supporting consumer choices and preferences, an incident may have occurred. Unfortunately, such incidents are not always detected and reported. Consequently, there’s a risk that they’ll keep happening again and again.

This article is designed to help break this cycle by challenging the current culture of what constitutes a medication incident. At a broader level, it also highlights the dangers of relying on a reactive compliance strategy that focuses solely on the stated aims of the ACQSC.

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About the Author

Ruth Greene

As a Registered Nurse with over 30 years’ experience across the healthcare industry, Ruth has been employed in a range of management and clinical positions, and for several years worked as a consultant in residential aged care. Understanding organisational governance, risk and related quality standards has been a pivotal part of her work practices and has included maintaining and monitoring of legislative and regulatory requirements, as well as developing linked policy documents. Ruth is Principal Consultant – Aged Care, at Ideagen CompliSpace.

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