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Aims and objectives This study is drawn from a larger project that aimed to identify the staffing and organisational factors influencing the quality of diabetes care for older people living in residential care in regional Victoria, Australia. The focus of the current study is on medication management for residents with diabetes. Background With a continuous rise in diabetes in the population, there is an associated increase in the prevalence of diabetes in aged care residential settings. However, there is little specific guidance on how to manage diabetes in older people living in institutional settings who experience multiple concurrent chronic conditions. Design A triangulation strategy consisting of three phases. Methods A one-shot cross-sectional survey ( n = 68) focus group interviews and a case file audit ( n = 20). Data were collected between May 2009-January 2010. Findings Staff knowledge of diabetes and its contemporary medication management was found to be suboptimal. Challenges to managing residents with diabetes included limited time, resident characteristics and communication systems. Additionally, the variability in medical support available to residents and a high level of polypharmacy added to the complexity of medication management of resident. Conclusions The current study suggests administering medicine to residents in aged care settings is difficult and has potentially serious medical, professional and economic consequences. Limitations to staff knowledge of contemporary diabetes care and medications potentially place residents with diabetes at risk of receiving less than optimal diabetes care. Relevance to clinical practice Providing evidence-based guidelines about diabetes care in residential care settings is essential to achieve acceptable outcomes and increase the quality of life for residents in public aged care. Continuing education programs in diabetes care specifically related to medication must be provided to all health professionals and encompass scope of practice. [ABSTRACT FROM AUTHOR]

Background: There has been limited assessment of the impact that automated medication dispensing machines have on the medication administration process, particularly in Australian emergency departments. The aim of this study is to examine the change in medication retrieval times, number of medications retrieved and staff perceptions before and after the installation of automated dispensing machines in an Australian emergency and trauma centre., Methods: A time and motion method recorded the time taken and number of medications retrieved from the medication room by emergency department staff, before and after the installation of two automated dispensing machines. Surveys were administered to staff members to elicit the perceived impact on clinical practice, utilising 5-point Likert scales., Results: A total of 954 medication retrievals (1030 medications) were recorded in the pre-implementation period and 842 (991 medications) in the post-implementation period. The mean time taken to retrieve any medication was significantly longer in the post-implementation period (+5.7s; p<0.01). For schedules 2, 3, 4 or unscheduled medications, the mean time increased by 26.9s (p<0.01), but decreased by 36.1s (p<0.01) for schedule 8 or 11 medications. The mean number of medications per retrieval increased slightly in the post implementation period (+0.10; p<0.01). Staff perceptions were that automated dispensing machines improve knowledge of medications on imprest (p=0.03) and reduced medication retrieval time (p<0.01)., Conclusions: This study found that the medication retrieval process was slower with automated dispensing machines for Schedules 2, 3, 4 and unscheduled medications, but quicker for Schedule 8 and 11 medications in an Australian emergency and trauma centre. Although retrieving medications took slightly longer overall, staff believed automated dispensing machines save time., (Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

Background: Though staff at Australian nursing homes (NHs) commonly administer medicines that have been re-packed into dose administration aids (DAAs) that organize medicines according to dose schedule, these pharmacy-supplied devices have not been extensively evaluated in the Australian setting., Objective: To audit the accuracy and suitability of re-packing medicines into DAAs (blister packs or sachets) for NHs and identify the proportion of DAAs with inaccurate or unsuitable medicine re-packing., Methods: Between January and June 2011, pharmacist researchers visited 49 randomly and purposively selected NHs from rural, regional, and metropolitan Victoria (Australia) to audit a sample of residents' newly prepared DAAs that contained all of their regularly re-packed medicines for 1 week. Over 1 or 2 days, the pharmacy-supplied DAAs were compared with the current prescriber-prepared NH medicine chart. Any occurrences of inaccurately re-packed medicines (discrepancies, with verification as necessary) or unsuitable medicine re-packing were recorded as DAA incidents and descriptive statistics was used to analyze the data., Results: Six hundred and eighty-four incidents occurring in 457 DAAs were detected from a total of 3959 DAAs audited for 1757 residents (incident rate of 11.5% of DAAs) from 49 participating NHs. Incidents were detected in 10.5% of blister packs and 14.5% of sachets. The top five incidents were unsuitable re-packing according to pharmaceutical guidelines (50.1%); added medicine (9.8%); incorrect quantity re-packed (5.4%); omitted medicine (5.3%); and damaged medicine (5.1%)., Conclusions: The incident rate of inaccurate or unsuitable medicine re-packing within DAAs supplied to NHs for use in medicine administration was higher than in previous research. Recommendations include using current findings in conjunction with further research to develop a quality improvement initiative to reduce DAA incident rates and improve NH standard of care., (Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.)

Aims and Objectives: To explore the effects of introducing an electronic medication management system on reported medication errors., Background: Computerised medication management systems have been found to improve medication safety; however, introducing medication management system into healthcare environments can create unanticipated or new problems and opportunities for medication error., Design: Descriptive analysis of medication error reports., Methods: This was a retrospective analysis of 359 incident reports drawn from the period of 1 May 2005-30 April 2006 across two hospital sites of a single not-for-profit private health service located in metropolitan Melbourne. Site A used a conventional pen and paper system for medication management, and Site B had introduced a computerised medication management system., Results: Most medication errors occurred at the nurse administration (71·5%) and prescribing (16·4%) stages of delivery. The most common medication error type reported at Site A was omission (33%), and at Site B was wrong documentation (24·2%). A higher proportion of errors at the prescribing phase, and less nurse administration errors, were detected at Site B where the medication management system was in use. The incidence of other, less frequent errors was similar across the two hospital sites., Conclusions: This examination of medication error reports suggests there are differences in the types of medication errors that are reported in association with the introduction of electronic medication management system compared to pen and paper system systems. The findings provide a new insight into the effects of introducing an electronic medication management system on the types of medication errors reported., Relevance to Clinical Practice: The findings provide a new insight into the types of medication errors that are reported during implementation of an electronic medication management system. Extra support for physicians prescribing practices should be considered., (© 2012 Blackwell Publishing Ltd.)

Background: Data on adverse drug reactions (ADRs) showed a rising trend in the elderly over 65 years using multiple medications., Aim: To identify registered nurses' (RNs) knowledge of medication management and ADRs in the elderly in aged care facilities; evaluate an education programme to increase pharmacology knowledge and prevent ADRs in the elderly; and develop a learning programme with a view to extending provision, if successful., Method: This exploratory study used a non-randomized pre- and post-test one group quasi-experimental design without comparators. It comprised a 23-item knowledge-based test questionnaire, one-hour teaching session and a self-directed learning package. The volunteer sample was RNs from residential aged care facilities, involved in medication management. Participants sat a pre-test immediately before the education, and post-test 4 weeks later (same questionnaire). Participants' perceptions obtained., Findings: Pre-test sample n = 58, post-test n = 40, attrition rate of 31%. Using Microsoft Excel 2000, descriptive statistical data analysis of overall pre- and post-test incorrect responses showed: pre-test proportion of incorrect responses = 0.40; post-test proportion of incorrect responses = 0.27; Z-test comparing pre- and post-tests scores of incorrect responses = 6.55 and one-sided P-value = 2.8E-11 (P < 0.001)., Conclusion and Implications: Pre-test showed knowledge deficits in medication management and ADRs in the elderly; post-test showed statistically significant improvement in RNs' knowledge. It highlighted a need for continuing professional education. Further studies are required on a larger sample of RNs in other aged care facilities, and on the clinical impact of education by investigating nursing practice and elderly residents' outcomes.