Medication Errors - Our Target is Zero!

The incorrect use and management of medications provides a significant risk for residents and has the potential to cause harm due to adverse drug reactions or events. Residential aged care facilities are required to develop and implement effective practices, policies and procedures which are regularly evaluated to ensure the safe administration and management of resident medications. The medication management system should also identify and manage risks and adopt strategies and interventions that support both staff and residents in maintaining a quality medication management process.

QPS Benchmarking has interviewed 3 managers from residential aged care homes to provide an insight into the practices that are proving to be effective in the prevention of medication errors. These homes are consistently performing well below and better than the QPS Industry Benchmark with all results validated during our comprehensive 3 step data cleansing process. Each of the following organisations have diverse medication management systems and process in place, have employed a wide range of varying strategies which have been outlined below and are all effective in preventing medication errors.

Inasmuch Community	Bushland Health Group	PresCare Vela & Lake Sherrin
Profile
Inasmuch Community located in Sussex Inlet, NSW provide a number of care and support options including Residential Aged Care, Home Care Package Services and self-care units. Inasmuch comprises of a 40-bed ageing in place Home as well as  Ainslie House which is a 30 bed secure dementia and high dependency unit.	Bushland Health Group is a not for profit organisation which provide residential aged care and retirement living services in the Manning Valley. Bushland Health Group have 3 residential aged care homes: Karingal Gardens and Bushland Place Hostel located in Taree and Banyula Lodge Hostel in Old Bar, NSW. Karingal Gardens comprises of 100 beds including a 40 bed secure dementia unit. Bushland Place Hostel has a total of 83 beds, Banyula Lodge Hostel 80 beds and each home includes a 40 bed secure dementia unit. In 2017 Bushland Health Group was named one of two inaugural winners of the National Innovation and Excellence in Aged Care Better Practice award for their Nurse Practitioner Palliative Care Model.	PresCare Vela is a 154 bed residential aged care home which includes a 30 bed secure dementia unit located in Carina, Brisbane and PresCare Lake Sherrin is a 48 bed residential aged care home which includes a 12 bed secure dementia unit located in Thornlands. PresCare is a not for profit organisation who have been caring for older Australians care since 1939 and provide a range of care options including Residential Aged Care, Home Care and Independent Living throughout Queensland. PresCare have 5 residential aged care homes with a 6th home in Townsville due to open in 2019.
Medication Error Results
We asked the Quality Care Manager, Debbie Simson at Inasmuch Community how the nil medication error results are achieved; and how high standards and performance has been sustained across all sites, over the last 3 years.	All 3 Bushland Heath Group residential aged care homes maintain very low incidents of medication errors and have achieved full compliance with zero errors reported during the past 12 month period. We asked Margaret Mills, Quality and Compliance Manager to share her effective medication system and strategies.	Lynda Bury, Facility Manager, from PresCare Vela and Lake Sherrin has shared her processes and strategies which have been successful in preventing medication errors, performing consistently well below the QPS industry benchmark for over 7 years.
Q1. Is your medication management system electronic or paper based?
Paper Based.	Electronic.	Electronic.
Q2. Which disciplines of staff are responsible for administering medications?
PCA’s administer from the Webster Pack. RN’s administer all PRN, S8 medications, patches and injections.	RN’s, EN’s, Cert 4 and some Cert 3 in our low care home.	Registered and Enrolled nurses.
Q3. What systems and processes are in place to identify and report medication errors?
If a PCA detects a medication error in a Webster pack or a charting error they notify the RN immediately, the RN then acts on this by either reporting back to the pharmacy or GP depending on the error. The S8 register is checked weekly. A monthly audit is carried out by the RN on medications charts, sign sheets, medication fridges and the medication trolley.	We use medication incident reports on our electronic medication management system. We have internal monthly monitoring, which allows us to keep a close eye on our medication errors across our 3 homes. We also undertake regular QPS Benchmarking Staff, Medical Officer and S8 Medication Audits which assist in identifying any errors. Packs are checked weekly on delivery, drug cupboards and fridges monthly and S8 drugs are checked daily.	We have an Incident Reporting framework that includes Policies & Procedures, audits, online incident reporting checked daily, trending and tracking - these all link into the Continuous Improvement process.
Q4. What policies and processes does the organisation have in place to follow up and action medication errors?
A medication incident report is completed. The staff member is counselled by RN, additional staff training is provided and the staff are given a competency re-assessment by RN if required. Incident reports are then taken to the WHS Committee monthly and reported for QPS Benchmarking.	We provide staff education and competency reviews are also undertaken. When an error occurs staff fill out a medication incident report form and I am notified of the errors. Staff are provided with individual feedback and are counselled by the manager. They are also referred to our educator to complete an education program and medication competency assessments. This process is followed for everyone i.e. agency, full time, part time or casual staff etc. We also have a 3 monthly Medication Advisory Committee (MAC) meeting where we table and discuss medication incident reports, identify any common error types, trends and strategies.	Appropriate clinical risk assessment, interventions and notification systems are in place. Staff member completes the online medication incident form, which is reviewed by senior clinical nurse; 1:1 meetings with staff member who has to complete a Medication Incident “Reflection Tool” which assists to identify causative factors and remedial action.
Q5. What are the strategies and practices in place to prevent medication errors?
All medication charts and Webster packs have resident’s photos. PRN medication is packed in a white Webster and kept in a separate draw and documented on a separate chart which is a different colour. All staff that administer medication have to undergo a medication competency assessment by the RN every 12 months or sooner if the RN thinks that this is necessary.  All staff that administer medication attend medication training annually given by the RN. There is also other training throughout the year on medication management provided by two external providers who specialize in Medication Management.	We discuss any errors at the monthly care staff meetings and reinforce the correct procedures and strategies.  We provide online training, assessments and competencies which are redone on a needs basis. Our educator and an external pharmacist provide regular tool box talks on the floor. Education material is also available for staff. New drug information and additional strategies are discussed with staff and communicated via notice board, minutes, and through the provision of tool box talks. Our educator has also developed a medication administration course along the same lines as Tafe to train staff.	A mandatory staff training program that includes online and practical based competency assessments. The training program aligns with legislative requirements and Australian Government Guiding principles for Medication Management in Residential Aged Care.
Q6. Do you undertake regular audits of medication charts, packs, Schedule 8 register and drug cupboard? What is your process?
Medication charts are checked monthly by the RN. PRN medication is checked weekly by the RN. S8 register is checked weekly. Regular monthly audits are completed by RN and QPS Benchmarking Medication Audits are also undertaken.	In addition to the regular QPS Benchmarking medication audits, packs are checked weekly on delivery, drug cupboards and fridges monthly. S8 drugs are checked daily. We discuss results of the audits and the errors with staff at MAC meetings and strategies are developed to prevent re-occurrence.	A regular auditing schedule is in place with reporting mechanisms and actioning to address gaps and discussed at the Medication Advisory Committee meetings.
Q7. Do you provide regular staff education and training? What forms, how often, is it mandatory, is it undertaken internally and/or externally?
Annual training is provided for staff by the RN. Meditrax visit 6 monthly and provide staff training in their visit and the Aged Care Channel at least once a year on medication. The RN also carries out training annually on Epi Pen and Insulin. This training is mandatory and undertaken internally. Staff are paid to attend all mandatory training.	We have an external pharmacist who undertakes regular medication reviews, on the days she is on site she gives toolbox talks on different medications, any trends etc. Our educator also provides regular tool box talks on the floor. We have online training, assessments, competencies and education material is provided to staff. Our educator provides a medication administration course for staff. Any new important information on medications and strategies are discussed and distributed to staff via notice board, minutes etc.	Internal online and practical competency based mandatory education assessments and post incident support and education to staff. Direct support and regular education sessions for staff are provided by our contracted clinical pharmacy services. Staff have access to the AusDI drug information database.
Q8. Do staff undertake medication competency tests, what is the frequency and when are these completed?
Staff that administer medications are given a competency assessment annually or sooner if the RN thinks that this is required.	We undertake staff medication competencies on employment and then on a needs basis. A staff competency review is completed when errors occur.	We provide internal online and practical competency based mandatory education assessments and post incident support and education for staff.
Q9. What is your process to orientate and train new staff, including agency staff to ensure they are competent in medication administration?
All new staff are given up to eight buddy shifts including medication administration under the supervision of another competent PCA. All new PCA staff have to undergo a medication competency assessment before commencing shifts on their own.	New staff complete online training, assessments and competencies when they start with us.  Some staff complete our medication administration course. New medication competent staff have practice rounds with other staff e.g. a buddy/supervisor. They then have a competency review when they are deemed ready.  The RN or educator observes the staff member whist undertaking the practice rounds to review practices and to ensure they are competent.	During their orientation period they complete the online medication administration theory and calculation test. A Buddy system is used to train and coach in the medication administration system and the supervisor assesses their medication administration competencies. A Medication Policy and Procedure Framework and Manual is available.