title: Exploring post-discharge medication process between hospitals, residential aged care facilities and community pharmacies
Creators: name: Sassoli, Maryam
Publisher: name: Griffith University
Year: 2024
Subjects: subject: residential aged care facilities (RACFs)
subject: post-discharge medication
subject: aged care

description: By 2050, the global population aged 60 and above will reach 2.1 billion. In Australia, 59% of people aged 65 or older use Residential Aged Care Facilities (RACFs). These facilities provide essential healthcare services, including medication management, because many elderly residents have chronic conditions that require extra care and take multiple medications. Over 95% of residents experience medication-related issues in RACFs and it becomes a concern. Effective communication of medication information during transitions from hospitals to RACFs is crucial, as about 20% of patients face medication issues during these transitions, leading to high post-discharge medical errors and readmission rates. The PDM process is an inter and intra-organisational-level process that involves medical team members, staff, medication information, and the flow and translation of this information between community pharmacies, hospitals, and RACFs. This information ultimately transforms into deliverable medication for patients. Human actions and interactions play a vital role in operating the PDM process, and these need to be investigated alongside the role of non-human actants. The existing literature provides limited insight into the structure and functioning of the PDM process between hospitals, RACFs, and community pharmacies. This study seeks to address this gap by comprehensively understanding the PDM process in practice. As such, this study aims to explore the PDM process within healthcare organisations to visualise and validate current practices, identify challenges and barriers, and provide recommendations for improving medication safety in RACFs. Specifically, it examines how medication information is transferred, translated, and transformed in RACFs and community pharmacies, considering their interfaces with hospitals. The study seeks to uncover the challenges in the PDM process and propose improvements from the perspectives of healthcare providers, including pharmacists and RACF registered nurses. A pragmatic qualitative approach was employed, collecting data from community pharmacies and RACFs in two phases. The first phase involved observations and semi-structured interviews with community pharmacists, while the second phase included interviews with registered nurses in RACFs. Thematic analysis was used to present the data, focusing on current practices, challenges, and improvement suggestions. Essomenic modelling and Actor-Network Theory (ANT) were utilised to map the PDM process and understand the interactions between human and non-human actants. The findings reveal significant challenges in translating medication information and in communication and collaboration between hospitals and RACFs, despite technological advancements. The study underscores the need for better translation of medication information into patient care. Although healthcare practitioners communicate effectively, the medication information is not being properly interpreted and applied in practice. This issue could be addressed by using integrated electronic post-discharge medication charts, such as the IRCMAC chart, where medication information can be shared and accessed by all healthcare professionals involved in patient care. However, it's important to note that simply exchanging medication information doesn't guarantee its effective translation into practice. This study contributes by bridging the gap between theoretical knowledge and practical application in healthcare processes, which often varies across organisations and practitioners. It also contributes to the understanding of healthcare processes and offers insights for enhancing the quality of healthcare services in aged care settings.