Unmet Needs for Transdermal Patch Management in Electronic Medication Administration Records: An Analysis of Data from 66 Aged Care Facilities

Abstract

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.

A systematic review of opioid prevalence in Australian residential aged care facilities

“…One RCT was included, 22 and the remaining studies were observational. Of 22 observational studies, 18 reported the cross‐sectional prevalence of opioid use across various assessment periods 8,23–39 . One study combined a baseline cross‐sectional and 12‐month longitudinal audit 40 .…”

“…Three studies investigated period prevalence using a cohort design over 12 months, 41 24 months 42 and 41 months 43 . The majority of the included studies (18/23) were published in 2015 or later 8,22–27,29–32,34,35,38–41,43 . Data were sourced from South Australia, 8,24–27 New South Wales, 33,37,42 Victoria, 31,40 Queensland, 22 Tasmania 39 and Western Australia 30 .…”

“…Of 22 observational studies, 18 reported the cross‐sectional prevalence of opioid use across various assessment periods. 8 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 One study combined a baseline cross‐sectional and 12‐month longitudinal audit. 40 Three studies investigated period prevalence using a cohort design over 12 months, 41 24 months 42 and 41 months.…”

Implementation of an Epidural Rounding Reminder in the Electronic Medical Record Improves Performance of Standardized Patient Assessments during Labor

“…12,13 By thoughtful evalu-ation of current practices, providers can identify valuable uses of CDS in countless workflows. 14 Our rounding reminder exemplifies a patient-specific relevant data display, one of the 53 types of front-end CDS tools defined by Wright et al in their CDS taxonomy. 15 This type of CDS can be highly effective, as prior work has shown that timely and welldesigned displays of salient information can assist with clinical task completion and make work easier for clinicians.…”

Daily Care Information System Requirements: Professional Service-Driven Service Blueprint Approach

“…52 The application of Internet of Things (IoT) technology has increased considerably, especially in vital sign monitoring. 53 Raban et al 54 reported that health care facilities can use EMRs as reminders to check and remove medication patches. Accordingly, LTS IS can be further integrated with EMRs or EHRs and connected with a main LTC system through a data exchange interface for relevant applications.…”