Impact of Medication Regimen Simplification on Medication Incidents in Residential Aged Care: SIMPLER Randomized Controlled Trial.

Nicolas Dugré,Jan Van Emden,Michelle Hogan,Ria E Hopkins,Megan Corlis,J Simon Bell,Janet K Sluggett,Jenni Ilomäki,Esa Y H Chen

doi:10.3390/jcm10051104

Abstract

In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we investigated the impact of a structured medication regimen simplification intervention on medication incidents in residential aged care facilities (RACFs) over a 12-month follow-up. A clinical pharmacist applied the validated 5-step Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) for 96 of the 99 participating residents in the four intervention RACFs. The 143 participating residents in the comparison RACFs received usual care. Over 12 months, medication incident rates were 95 and 66 per 100 resident-years in the intervention and comparison groups, respectively (adjusted incident rate ratio (IRR) 1.13; 95% confidence interval (CI) 0.53–2.38). The 12-month pre/post incident rate almost halved among participants in the intervention group (adjusted IRR 0.56; 95%CI 0.38–0.80). A significant reduction in 12-month pre/post incident rate was also observed in the comparison group (adjusted IRR 0.67, 95%CI 0.50–0.90). Medication incidents over 12 months were often minor in severity. Declines in 12-month pre/post incident rates were observed in both study arms; however, rates were not significantly different among residents who received and did not receive a one-off structured medication regimen simplification intervention.

Highlights

IntroductionMedication errors are estimated to cost USD 42 billion annually, or 0.7% of global health expenditure [1]
The rate of medication incidents was greater in the intervention arm compared to the comparison arm at four-month follow-up in the unadjusted analyses (incident rate ratio (IRR) 1.91, 95% confidence interval (CI) 1.02 to 3.67), no significant difference was observed after adjustment for the rate of medication incidents in the four months pre-study entry (IRR 1.55, 95% CI 0.81 to 2.91, p = 0.17)
An experienced clinical pharmacist reviewed medication charts for participants in the four intervention residential aged care facilities (RACFs) and used the principles outlined in the MRS

Summary

Introduction

Medication errors are estimated to cost USD 42 billion annually, or 0.7% of global health expenditure [1]. Medication Without Harm is the World Health Organization’s (WHO) Third Global Patient Safety Challenge, and Medication Safety was recently declared an Australian national health priority area [2,3]. Medication errors and incidents have been defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer” [4]. A review of 36 studies across all United Kingdom (UK) National Health Service (NHS) settings reported medication error rates from 0.2% (prescribing error rate at hospital discharge) to 90.6%

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