Evaluating a Quality Improvement Intervention Targeted at the Medicine Supply Service from Australian Pharmacies to Residential Aged Care Facilities

Australian community pharmacies often supply medicines to residential aged care facilities (RACFs) in dose administration aids (DAAs). These medicine organisers may not always accurately reflect current medication regimens, or medicines may be unsuitably packed according to storage requirements. This study evaluated the impact of an intervention, comprising education and a toolkit for 45 RACFs and affiliated pharmacies, on the frequency and severity of these incidents. Methods: At least three months after the intervention was introduced, DAA audits were conducted at 45 Victorian RACFs from September 2012 to January 2013. A pharmacist checked pharmacy-supplied DAAs against RACF medicine records and classified identified incidents according to their potential risk of causing an adverse event. Findings were compared to pre-intervention DAA audit data. Descriptive statistics were calculated using SPSS 19 and statistical significance was determined using the Pearson’s Chi-squared test. Ethics approval was obtained from the Human Research Ethics Committees of Monash University, Ballarat Health Services and St John of God Healthcare, and Barwon Health. Results: Of 2,389 DAAs audited from 39 pharmacies for 983 residents, 770 incidents involving 502 DAAs were identified (21.0% incident rate). The DAA incident rate significantly increased post-intervention (21.0%), compared to pre-intervention (11.5%) (p!0.001). Significant increases occurred in the proportion of DAAs experiencing incidents of added medicines and inaccurate medicine division (p!0.001). However, when compared to the total number of incidents identified, unsuitable medicine packing (p!0.001) and omitted medicines (p!0.001) significantly decreased. The majority of incidents identified post-intervention were of a lower risk category. Conclusions: The overall DAA incident rate increased post-intervention, however, certain incident types occurred less frequently and incident severity decreased overall. An intervention more specifically designed for the RACF or pharmacy, targeting specific DAA incident types, may be more successful at reducing the occurrence of DAA incidents and improving pharmacy medicine supply to RACFs.