Strategies to improve medicines management at home

A new research project looking at how to reduce demands on the community aged care workforce while also improving the safety of medication use will investigate a range of strategies, including the potential use of new technologies.

The project, part of a number that will share in $10.2 million in funding announced by the federal Minister for Ageing Mark Butler recently, will look at ways of developing a model of care to support the elderly to better manage their medications at home.

While only a small part of the research focus, the team will investigate the use of video conferencing and a new automatic pill dispensing technology to see if patients can be safely supported with their medications at home and at the same time reduce the amount of daily visits required by community nurses.

The 18-month joint project will be led by Austin Health in partnership with Monash University and the Royal District Nursing Service (RDNS) and is funded by Health Workforce Australia.

Austin Health senior pharmacist Rohan Elliott said the main focus was to look at how the workforce could potentially be reconfigured to move some tasks from registered nurses to enrolled nurses or personal care assistants and to find ways to help older people remain independent for longer by providing better assessments and education and training.

“The driver for the project is primarily the increasing demand on the community aged care workforce due to the ageing population, and projected shortages of registered nurses,” Mr Elliott, also a clinical senior lecturer at Monash's Centre for Medicine Use and Safety, said. “There are a range of providers delivering medication management support services in the community but the focus of our project is the RDNS, who predominantly use registered nurses to provide medication management support.

“Almost 60 per cent of RDNS home visits are related to medication management. They provide medication support for about 7000 clients each year. Health Workforce Australia is primarily interested in how you can refigure that workforce, shifting tasks to enrolled nurses or personal care assistants, such as medication prompting.”

Mr Elliott said another way to reduce pressure on the workforce was to use technology. RDNS recently obtained some funding under the Victorian government's Broadband-Enabled Information Project (BEIP), which will investigate the use of video conferencing to potentially reduce the number of daily visits nurses have to make.

That project will recruit 50 consumers to see if their daily medication use can be monitored by video conference six days a week, with one day a week involving a physical visit.

Mr Elliott said that where appropriate, the workforce project may also tap into the BEIP project. “RDNS has a couple of sites that are able to offer video conferencing as an alternative to doing daily home visits,” he said. “They'd do a weekly home visit and on the other days they'd call the patient up on their video conferencing device, which will be set up on their kitchen bench. The nurse can prompt and observe the person taking the medications remotely.”

Another part of the project will look at whether a new automatic medications dispensing technology called Medido could be helpful in reducing workforce demands.

Medido is an automated dose administration aid (DAA) designed in the Netherlands which automatically dispenses the correct dose of medications at the required time. It involves a SIM-controlled device linked to a web browser, through which the prescriber can schedule the correct time, dose and type of medication. Pharmacists pack these into a week or fortnight's worth of individual sachets, which are then inserted into the device.

When the programmed time approaches, both visual and audio alarms are automatically activated to tell the person that their medication is due. The person simply presses OK and the DAA sachet is ejected from the device. For older people, the top of the sachet is cut so they don't have trouble opening it.

“If they don't push the okay button, the device has a SIM card in it and it can send an SMS to whoever you program in, be it the next of kin or the RDNS or whoever you set it up for,” Mr Elliott said.

He said while these new technologies are interesting, they are probably not suitable for the majority of people who need medication support, many of whom have cognitive impairments.

“The people who tend to need medication management support are not often functioning at the level that they can understand the technology,” he said. “For example they may turn the power off every night before they go to bed or do things that mess up the system. However, it may be a solution for a minority of people.”

Posted in Australian eHealth

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