Unmet Needs for Transdermal Patch Management in Electronic Medication Administration Records: An Analysis of Data from 66 Aged Care FacilitiesFunding This work was supported by an Australian Research Council Linkage Grant (grant number LP120200814); a National Health and Medical Research Council (NHMRC) Early Career Fellowship (grant number APP1143941 to M.Z.R); and the NHMRC Partnership Centre for Health System Sustainability (grant number 9100002).
Background Transdermal medication patches have caused serious adverse events in residential aged care facilities (RACFs). Preliminary research suggests that facilities are using a workaround consisting of manually entered reminders in their electronic medication administration records (eMARs) to prompt staff to check and remove patches, because the eMAR does not support these tasks. However, the prevalence and factors associated with use of this workaround among facilities is unknown.
Objectives The objectives of this study were to (1) examine the frequency and consistency with which manual reminders to check and remove transdermal patches were used in facility eMARs, and (2) identify resident and facility factors associated with reminder use, to inform eMAR redesign.
Methods This was a retrospective cross-sectional analysis of eMAR data from 66 Australian RACFs including 4,787 permanent residents, aged ≥65 years in January 2017. Prevalence of the use of reminders to check and remove patches, and consistency in their application within facilities were examined. Generalized estimating equations were used to determine factors associated with use of manual reminders.
Results One in five (n = 937) residents used a patch, and 83.6% of patches contained opioids, a high-risk medicine. 56.9% of facilities implemented manually entered check patch reminders in the eMAR, and 72.3% implemented remove reminders. The reminders were applied inconsistently, with only half of these facilities having reminders for all residents with patches. Residents in facilities in regional areas were more likely to have a check reminder compared with those in major cities (adjusted odds ratio = 4.72 [95% confidence interval: 1.69–13.20]).
Conclusion Transdermal patches containing high-risk medicines are frequently used in RACFs, but their safe administration is not supported by a widely implemented eMAR. The frequent, but inconsistent use of a workaround to manually enter reminders indicates an unmet need for new eMAR functionality to improve safety.
Keywordsmedication therapy management - homes for the aged - nursing homes - electronic health records - transdermal patch - narcotics - system design - data
Preliminary results from this study were presented at the 20th Congress of the International Ergonomics Association, August 26 to 30, 2018, Florence, Italy.
Protection of Human and Animal Subjects
This research was approved by the University of New South Wales (HCI13091) and the Macquarie University Human Research Ethics Committees (5201401005). Permission for accessing data was granted through a Collaborative Research Agreement between the University of New South Wales and the aged care provider.
Received: 01 July 2020
Accepted: 05 October 2020
09 December 2020 (online)
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