20% Of Australians Take More Than 10 Medicines

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A healthy breakup? What happens when your patient leaves your care …? Most people take medicine at some point during the course of a year. They may take prescription medicines, over-the-counter medicines and complementary medicines, sometimes together and sometimes not. What we do know for certain is that people taking 5 or more medicines are at a higher risk of medicine-related problems, and that this risk increases with the number of medicines taken.

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Work done by the Australian Commission on Safety and Quality in Health Care (ACSQHC) suggests that 12% of all medical admissions and 20% to 30% of all hospital admissions for people aged 65 years and over are estimated to be medication-related.
The ACQSHC has highlighted that the medicines prescribed for people when they enter and leave a hospital are frequently based on incorrect information. A recently published study into referrals from GPs for patients presenting to an emergency department with congestive cardiac failure found that 90% of referral letters had at least one discrepancy between the medicines listed and the medicines actually dispensed for, or purchased by, the patient. On average there were around 4 discrepancies per patient.
There are similar issues when people leave hospital. Back in the late 1990s the evidence showed us that at least one medicine was not listed on most discharge summaries. More recent studies have still found at least one discrepancy in up to 80% of discharge summaries. New medicines commenced in hospital and medicines to be taken when required for symptom control are often not recorded.
People discharged from hospital into a residential care facility face additional issues. The need for a medication administration chart to be written when the person is admitted or re-admitted to a residential care facility has been found to be the most common reason for delays in administration of medicines.
However, a major study of a pharmacist-prepared interim residential care medication administration chart, based on the person’s current medication list, resulted in:

• significantly fewer patients having delayed doses of medicines;


• significantly fewer patients requiring charts to be written by locum staff; and


• significantly less workaround practices by residential aged care staff to avoid missed doses.

Let’s Reconcile
There is sound evidence that medication errors at transitions of care can be reduced through the process of medication reconciliation, which includes the curation of a current and complete medication list.
Medication lists provide a ‘snapshot’ of the patient’s current medicines, and are usually curated from multiple sources and a patient interview, using a structured interview technique.
Both the ACSQHC and the Society of Hospital Pharmacists of Australia (SHPA) believe that an up-to-date and accurate medication list is essential for ensuring safe prescribing and continuity of medication management.
The ACSQHC recommends that there should always be a comprehensive list of the patient’s ongoing medicines, current at the point of discharge, whether or not all medicines are supplied by the hospital. In addition, the percentage of patients whose discharge summaries contain a current, accurate and comprehensive list of medicines is one of the ACSQHC’s National Quality Use of Medicines Indicators for Australian Hospitals.
Let’s Collaborate
Performing a medication reconciliation and curating a medication list can be time consuming and requires a specific skill set. Australian and overseas evidence suggests that medication reconciliation is poorly done by staff who are not ‘focused’ on medication management. Pharmacists have been shown to obtain a more accurate medication history and in a shorter time than other health professionals. However, most hospitals do not have enough pharmacists to provide this service to every patient, so one alternative is to have pharmacists provide training to other health professionals to improve the accuracy and efficiency of this activity.
There have been mixed results from the implementation of electronic medication management systems (eMMS) in improving the quality and availability of medication lists. Implementing an eMMS is more than just replacing a paper-based form with an electronic or screen-based forms. As with any medication reconciliation, it requires a review of how medicines are prescribed, supplied and administered and how medication lists are curated and recorded, irrespective of whether an electronic or hard copy format is used to record the information.
For people discharged from hospital into residential care the routine production of an interim residential care medication administration is to be encouraged. This helps to facilitate the administration of the person’s medicines when they are transferred to a residential care facility.
The ACQHS studies show that consumers report poor communication, lack of information and lack of co-ordination of care as common reasons for problems arising from medicine use. This isn’t new information, but it is information that is vital to considering our individual and collective role in changing these statistics.
SHPA’s position is that the prescribing of medicines is best undertaken via a collaborative model, underpinned by timely and effective communication between the health care team and the patient. This includes a ‘virtuous circle’ approach where a readily accessible complete and current medication list is always available to support the evaluation and establish the basis for changes to a patient’s medicine treatment.
We are all accountable for ensuring that our patients are safe in our care, and transitioned just as safely and effectively to the next setting as if we had never left them.

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“Problems with medicines and medicinerelated adverse events are the most common type of adverse events reported by patients in their transition from hospital to home.”

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The ACQSHC uses the following description for either hard copy or electronic medication lists:
Medication list refers to a list of the medicines provided to the patient or carer, which includes the following information:

• all medicines to be taken by the patient, including the dose, frequency and indication for each medicine. All prescription, overthe- counter, and complementary medicines should be included, as well as all regular, intermittent and “as required” medicines. The list should include medicines to be taken by all routes i.e. oral, topical, parenteral etc.


• information about changes to therapy, including dose changes, new medicines and ceased medicines.


• any medicines NOT to be taken by the patient, including those causing allergies/adverse drug reactions.

Reducing the risks
We know that transition of care is a prime marker for the occurrence of medication problems and we can bring the risks down by;
- medication reconciliation on admission.
- complete medication lists.
- interim medication charts for those transferring to RACF.
- clear and complete written and verbal communication.
Kristin Michaels
CEO Society of Hospital Pharmacists of Australia
Kristin Michaels is the Chief Executive Officer of The Society of Hospital Pharmacists of Australia, with a keen interest and experience in health system design. She is a seasoned Board Director in both the primary, acute and aged care sectors. Kristin holds qualifications in Arts, Organisational Leadership, Governance and Health Service Management. She is a Fellow of the Australian Institute of Company Directors and is accredited as an International Partnership Broker.