Careless staff may explain why medication errors are more likely to occur in nursing homes than for patients self-administering their medicines at home, research by the Victorian Poisons Information Centre suggests.  

A study of medication incidents involving 97 nursing home residents and over 600 people living at home found a significantly increased rate of medication error in nursing homes, caused by staffing issues such as carelessness, distraction, staff not following standard procedures or being unfamiliar with the patient.  

Taking the wrong medication or someone else’s medications was more common in nursing homes, whereas in the home setting, errors were more likely to involve incorrect dosages.  

However home cases had slightly higher rates of error for medications where, if taken in overdose, consequences could be considerable. These include bupropion, calcium channel blockers and tramadol, say the authors of the study in the Australia and NZ Journal of Public Health (33:388-94).  

Cases were reported of patients at home inadvertently taking cat or dog tablets, and oral ingestion of vaginal pessaries, suppositories and fish tank tablets.  

None of the cases had a serious outcome but it was concerning that the errors in nursing homes were largely preventable and diverted legitimate use of healthcare resources elsewhere, the authors say.  

“The significant differences in the nature and causes of errors...likely reflect the differing administrators and procedures. There is considerable scope for prevention initiatives. In particular, attention should be directed to staffing, training and procedural issues within [nursing homes],” they conclude.   

Source: www.6minutes.com.au - by Jared Reed  

Comments:

RACFs have a high proportion of patients with chronic health conditions, and yet they have low or even zero medical supervision. GPs no longer visit RACFs with good reason, because there is no remuneration, because of the red tape and because their medication systems are just incompatible with primary care.
It's a case of 'all care (if you're lucky) and no responsibilty'. The government should, as a minimum, accept that every RACF must have a medical superintendant, instead of trying to get pharmacists and ambos to fill the gaps.

Posted by Dr Nick Riviera 24/08/2009 11:35:22 PM

I think calling the staff "careless" misrepresents the serious and endemic dysfunction that exists in our nursing homes. I think if you looked at the wellbeing of the staff you might find burnout, fatigue, overwork, expectations and demands beyond the capacity of the person (by their education and training) to be the major issue

Posted by Ewen McPhee 25/08/2009 8:37:09 AM

How true. The previous respondents are correct on both sides of the equation. My mother has suffered from a mental health disorder for 25 years. Within the first six months of entering a RACF she had a psychotic episode and was eventually detained in a public psychiatric hospital for 28 days. This had never happened to her before (other than at first diagnosis) and was frightening for her and perplexing to us. The cause? Agency staff over the festive and holiday season not checking that she actually swallowed her antipsychotic medication.

However I have since found the same medication on the floor of her room more than once when there are new staff. After reporting the incident myself I discovered that they have only one EN to do the medication rounds for the whole facility. When she was on leave or absent it fell onto the shoulders of overstretched care staff.

Medications are in webster packs and staff are "credentialed" to perform this task. Credentialed by whom? To what standard of training? Some are diligent, some are not. More and more care staff are new immigrants. When my mother had cataract surgery and required a complex post op regime of three different eye drops over four weeks I just shuddered to think what really eventuated. I was led to believe that the actual RN at the facility spends most of her time being an administrator ensuring the accreditation standards are adhered to, on paper of course.

When my mother entered the facility the actual manager/director at the time was a doctor. Yes, this is a most unbelievable state of affairs. The people with the most qualifications were chasing funds and the least qualified were defacto medicos. When you get to the crux of the problem and what happens in RACF's it is all down to the funding. The bean counters, the ones who run the facilities but especially the ones in Canberra are partly to blame.

How can you provide care for approximately $160 per day? (govt funds plus pension contribution). However the real cause of the problems are the actual bureaucrats who write the guidelines for "best practice". I have read the accreditation standards and compared them with what I have observed over the past few years.

I hope I never end up in a RACF by default.

Posted by Natalie 25/08/2009 5:15:07 PM