A provider’s role in protecting residents during medication management

As an aged care leader, your own understanding of medication management may differ from that of residents and care recipients. The sector itself is faced with a number of rules to ensure the safety of those it supports, but do those rules truly see the person at the centre of the system with evolving needs?

The sector domain doesn’t make a difference when considering the needs of an older body and the nine rights of medication management. The ageing body is unfortunately for us all, summed up by the fact we get drier, shorter, become “more podgy”, and therefore need less medicine doses.

Because of the decrease in total body water of the older body, a ‘usual’ medicine dose will result in a higher concentration of medicine distribution as there is less fluid volume to dilute the medicine. This means smaller dosages are required, and incidentally, this also applies to alcohol, i.e. there is an increased sensitivity to alcohol and less body fluid to dilute the intake.

Many of the adverse drug reactions experienced by older people result from the prolonged higher tissue levels caused by the decreased excretory capacity of the kidneys and skin and the higher fat volume in the older body where medicines may be stored means they linger for longer. 

Examples of drugs affected are Digoxin, Beta blocking agents, and antibiotics – especially amino-glycosides such as Streptomycin and Gentamicin. Caution is also warned when using diuretics as they may precipitate an electrolyte imbalance e.g. hyponatremia and hypocalcaemia if too much fluid is excreted too quickly.

Interstitial fluid volume per unit is lower and lean tissue mass per unit of body weight is reduced. There is a loss of bone minerals as we age and some reduction of diffusion capacity at the alveolar membrane with the effective mass of the kidney reduced, and the glomerular filtration rate reduced meaning medicine excretion is slower.

Despite these age-related changes to the internal biological homeostatic mechanisms, the pH of blood is usually maintained within normal limits, only impaired when extra stress (such as physical illness) is imposed. But there is always a dehydration risk when an older person doesn’t remember to drink or cannot obtain their own.

This means that considering five or even seven rights of medication administration isn’t sufficient when supporting older people. Medication management requires addressing at least nine rights.

We need to ensure the right person, medicine, route, time and dose, but we also must have the right documentation available to know what else to consider before prescribing, ensure the medicine has the right action for the older person’s body, that the medicine is in the right form, especially for those with swallowing difficulties, and is achieving the right response. 

Medication management software systems can ensure these rights are considered and risk management strategies are in-built into the design of the system. Considerations include ensuring:

• The person’s photo is current and available everywhere throughout the admin process
• A prescription is captured and communicated to staff in real-time, so that new doses, new medicines, ceased details and changes are immediately available to staff, critical to ensuring no misadventures with medicines
• Generic medicine names are used and referred to, to minimise mistaken medicine identity
• Allergies and sensitivities need to be upfront and obvious
• The right medicine route and form are clearly presented for staff administering medications, minimising the risk of an older person choking on a medicine – especially when choking remains one of the highest causes of death in older persons

The right dose must also be supplemented with ensuring the right frequency of the medicine is clearly articulated with the right times of administration alerted to staff for medicine consumption.

But just as important is ensuring the right nursing and clinical, as well as medical documentation, is upfront and central for administering staff so they know what are the medical diagnoses, but also the persons’ communication ability. Staff need to know the person may say yes to everything as they don’t have the required level of understanding of English or comprehension of any language.

Whether older persons are in residential care or are supported in their own homes or the community, they need support that considers every aspect of their life when considering medication management, their lifestyle, their homelife and situations.

Gerontology and medication management are not just about medical management and tablets. Such support requires a detailed and considered approach to the persons social situation, the reason a prescription is required, with relevant instructions for staff administering medications so that they get it right, every time.

A system that alerts, advises, reports and prompts, one that considers the entire nursing process of assessment, planning, intervention and evaluation, minimises risk. 

So next time you think of medication management, take the time to consider all nine rights, the ageing body and how your procedures and the system you are using, has actually considered all these concepts and presents the data to staff in a manner that supports all needs.

Leecare is the team behind Platinum6, aged care’s leading software and electronic health record platform. You will find more information on how to strengthen your care delivery, compliance and medication management on Leecare’s website.