Medicine communication from hospital to residential aged care facilities: a cross-sectional survey of aged care facility staff

Medicine communication from hospital to residential aged care facilities: a cross-sectional survey of aged care facility staff | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Medicine communication from hospital to residential aged care facilities: a cross-sectional survey of aged care facility staff Sarah Browning, Rachael Raleigh, Laetitia Hattingh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4769195/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Sep, 2024 Read the published version in International Journal of Clinical Pharmacy → Version 1 posted 6 You are reading this latest preprint version Abstract Background : Continuity of medicines management can be compromised when older people are transferred between hospital and residential aged care facilities. Aim : This study explored medicine management practices at facilities during patients’ transfer of care from hospital, and staff experiences with medicines information handover from hospitals. Method : An electronic cross-sectional questionnaire sent to all residential aged care facilities within a metropolitan region, February to April 2022. The survey comprised 23 questions covering facilities’ profiles, medicines management practices, and medicine management at transfer of care from hospital. Results : Of 53 listed facilities, thirty-one (58.5%) responded representing > 80% banner organisations. Facilities varied in size ranging between < 50 and 200 beds. A variety of services were provided with 87.1% offering more than one level of care. Responses indicated differences in medicines management processes with 19.4% solely using hardcopy medication charts. Handover from hospitals to manage patients’ medicines at transfer was inconsistent with only 48.4% reporting consistently receiving appropriate documentation. Conclusion : Diverse processes and practices exist for medicines management in residential aged care facilities for routine activities and when residents transfer from hospital to facilities. Medicine communication received from hospital during discharge to a facility varies considerably, potentially compromising patient safety and care. transition of care medicine handover medication-related harm hospital pharmacy aged care facility geriatric medicine management Impact of findings on practice statements Medicine handover information from hospital is not consistently received by aged care facilities at discharge from hospital A variety of practices and processes around medication management exist within aged care facilities Further exploration is required to determine barriers and facilitators impacting quality medicine management at transfer of care to aged care facilities INTRODUCTION Internationally, there is an increase in the proportion of older persons [ 1 ] and it is estimated that the number of people aged 60 years and older worldwide will increase from 1 billion in 2019 to 1.4 billion by 2030 and 2.1 billion in 2050. Australian 2020 data showed there were approximately 4.2 million older Australians (aged ≥ 65), comprising 16% of the totalpopulation [ 2 ]. Older people often have co-morbidities with increased prevalence of polypharmacy, medication-related problems and hospital admissions [ 3 , 4 , 5 ].An estimated 245,000 Australian people permanently lived in a residential aged care facility (RACF) between 2019 and 2020 [ 2 ]. Admission to and discharge from hospital is known to be a high-risk period for medication-related harm especially for the older population [ 6 , 7 ] Research shows that 91% of aged care residents take at least five regular medicines and 65% take more than 10 regular medicines daily and 18% of unplanned hospital admissions for aged care residents are a result of inappropriate medicine use[ 8 , 9 ].Quality medicines communication and handover is therefore vital during transfer of care to facilitate safe care and avoid medication errors or missed doses [ 10 ]. The 2021 Australian Royal Commission into Aged Care report raised the need for improvements at interfaces of care, including the provision of clinical information from residences to hospitals and vice versa [ 11 ] and an up-to-date summary of health status and current medications. A need was identified to explore the medicine handover and management during transfer of care to RACFs from two public hospitals in a metropolitan region. RACFs are spread across the region over approximately a 40km radius. AIM The aim of this study was to explore medicine management practices at RACFs during transfer of care from hospital and staff experiences with medicines information handover. ETHICS APPROVAL Ethics approval was received from the Gold Coast Hospital and Health Service (GCHHS) Human Research Ethics Committee (HREC/2021/QGC/70705). METHOD Cross-sectional survey methodology was used through an online questionnaire to explore practices and staff experiences in relation to the communication of medicines information at transfer of care from hospital. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed [ 12 ]. Setting GCHHS is a tertiary service within a metropolitan region, providing care to a population of 625,087 people. At discharge from hospital, a RACF resident ideally receives an Electronic Discharge Summary (EDS), supply of newly prescribed or changed medicine, an Interim Medication Administration Record (IMAR) and if returning to RACF from the emergency department an Emergency Department Discharge Medication Administration Record (EDDMAR). Provision of this information is a state-based initiative in Queensland, Australia. Other states and territories in Australia have variations of these documents. In Australia, RACFs are approved by the Australian Government and managed by companies, charities, and other not-for-profit groups. [ 8 ] Some organisations manage multiple facilities, referred to as banner organisations. Questionnaire Development The questionnaire comprised 23 questions divided into three sections capturing facility profile (4 questions), clinical handover procedures (7 questions) and medicine management processes (12 questions). Following face and content validation by hospital pharmacists, a nurse practitioner specialising in aged care, medical practitioner, nurse and clinical trial co-ordinator, and senior pharmacy academic, some questions were modified. The questionnaire was formatted into MS Form and pilot tested by three pharmacists and a nurse to ensure flow and accuracy. An electronic link was incorporated into an email sent to RACFs with the participant information sheet. Participant Selection Fifty-seven facilities were listed within the region as RACFs in Appendix 12 of the state Health Facilities list representing 26 banner organisations [ 13 ]. Upon initial contact, four of the listed facilities were no longer operating and excluded. The 53 RACFs were contacted via telephone to obtain an email address for the facility representative considered most appropriate to answer workload-related medicines questions. Data collection An email invitation was sent February 2022 with a study information sheet that explained completion of the questionnaire was regarded as complied consent; the questionnaire remained open until April 2022. There were two follow up telephone calls and emails to non-respondents. The questionnaire was completed by respondents online or over the telephone with a member of the research team entering responses with time automatically recorded. Data analysis Questionnaire data was tabulated using Microsoft Excel© [ 14 ] to summarise participants’ demographic and facility profile details, medicine handover from hospitals and medicine management procedures, including descriptive statistics with frequencies and percentages. RESULTS In total 31/53 (58.5%) responses were received representing > 80% of banner RACFs within the region. The average duration to complete 30 of the questionnaires was 8.2 mins (SD ± 4.1). One was left open for an extended period and the duration therefore not included. Four care managers, five clinical managers, 11 clinical care co-ordinators, two directors of care, two clinical leads, six registered nurses and one service manager completed the questionnaire (Table 1 ). Facility size varied between < 50 and 150–200 residents with most facilities accommodating between 50–100 residents. Multiple levels of care were offered by 87.1% of facilities; 18.5% offered independent living. Table 1 Demographic and facility profile information (n = 31) Respondent position No Percentage Service manager 1 3.2% Head of care/Director of care 2 6.5% Clinical lead 2 6.5% Care manager 4 12.9% Clinical care co-ordinator 5 16.1% Registered nurse 6 19.4% Clinical manager 11 35.5% Number of residents at facility < 50 5 16.1% 50–100 14 45.2% 100–150 11 35.5% 150–200 1 3.2% Offer varying levels of care No 4 12.9% Yes 27 87.1% Levels of care offered. Respondents selected all that apply (n = 27) High care 25 92.3% Low care 23 85.2% Palliative care 23 85.2% Independent living 5 18.5% Dementia care 26 96.3% Permanent care 26 96.3% Respondents estimated the percentage of time (rounded to the nearest 10%) they received medicines handover information in the previous six months: Almost half (14/31; 48.4%) indicated they received a pharmacist generated IMAR for every resident transfer and 87.1% (27/31) stated they used the IMAR for medicine management at transfer (Table 2 ). Medicine communication via discharge summaries were less frequently reported with only 32.3% (10/31) stating they always received a discharge summary. Only 35.5% (11/31) reported they were familiar with the EDDMAR with 90.9% (10/11) familiar would use an EDDMAR if it were provided. Table 2 Medicine communication and management processes Percentage of time IMAR received No. Percentage 100% 15 48.4% 90% 3 9.7% 80% 5 16.1% 70% 2 6.5% 60% 1 3.2% 50% 3 9.7% 20% 1 3.2% 10% 1 3.2% Will facility use the IMAR? Yes 27 87.1% No 1 3.2% Sometimes 3 9.7% How often is a discharge summary received? 100% 10 32.3% 90% 5 16.1% 80% 5 16.1% 60% 2 6.5% 50% 2 6.5% 40% 4 12.9% 30% 1 3.2% 10% 2 6.5% Do you know what the EDDMAR is? yes 11 35.5% no 20 64.5% Have you received an EDDMAR? (n = 11) Yes 5 45.5% No 6 54.5% How often do you receive an EDDMAR? (n = 5) Every 3–4 months 3 60.0% Every month 2 40.0% Which supply pharmacy do you use? Local community pharmacy 9 29.0% Larger regional company 11 35.5% Hospital based service 3 9.7% Other 8 25.8% Type of medicine administration chart used Electronic 11 35.5% Paper 6 19.4% Both 14 45.2% Which medicines aid do you use? Multiple selection option question Blister/bubble 15 48.4% Sachet system 27 87.1% Compartmentalised plastic boxes 2 6.5% Automated medicines dispensing device 1 3.2% Do you have an Imprest? Yes 31 100% Do you routinely use the Imprest? Yes 21 67.7% No 10 32.3% If a resident is discharged does the hospital need to supply medicines? Yes 26 83.9% No 5 16.1% How can staff administer medicines? Respondents to select all that apply Using IMAR and labelled medicines 29 93.5% From a pharmacist labelled medicine 16 51.6% From a hospital medicines chart 26 83.9% From a dose administration aid (DAA) 17 54.8% Can staff make temporary changes to a webster pack? Yes 20 64.5% No 11 35.5% Do you have an error reporting system Yes 29 93.5% No 2 6.5% The third section of the questionnaire outlined a wide variety of processes used for current medicines management (Table 2 ). A range of supply pharmacies were utilised including local ones and larger companies based outside of the region. A diverse arrangement of medicine administration recording systems were used with 6/31 (19.4%) using paper only. Dose Administration Aids were used in all but one facility. Many facilities used multiple forms of administration aids, with 27/31 (87.1%) using sachet systems, and 15/31 (48.4%) using blister or bubble packs. Most facilities had a supply of medicines available for emergencies such as the initiation of antibiotics however they were not routinely used with the first option to contact a pharmacy for supply. Facilities reported varied processes for medicine management. Most facilities 26/31 (83.9%) required hospitals to supply medicines when patients are discharged. With respect to continuing medicines and administration of medicines from hospital documentation provided, processes in place differed between facilities with 2/31 (6.5%) reporting not administering from hospital supplied records (e.g., IMAR provided). These facilities required all administration systems to be updated by the facility doctor and/or pharmacy before implementing changes to the resident’s medicine. Most facilities (20/31; 64.5%) would make required adjustments without pharmacy involvement while 11/31 (35.5%) required their community pharmacy to repack the administration aid before use. DISCUSSION Statement of key findings and interpretation Studies have highlighted that transition of care between hospital and RACFs is a high-risk time for medication-related harm [ 10 ]. Consistent and clear medicine handover information is vital for safe transitions of care. [ 11 ] Findings from this study showed there are varied processes and procedures at facilities when patients are transferred from hospital which could compromise patient care. The Australian Commission on Safety and Quality guidelines detail comprehensive clinical handover requirements at transfer of care between hospitals and RACFs [ 15 ]. A key clinical handover principle is clear and accurate communication of relevant and current patient information, including a current medicines list. 12 The World Health Organisation’s third Global Patient Safety Challenge similarly highlights the need for quality medicine handover during transitions of care [ 16 ]. Discharge summaries and medication records incorporate essential information for aged care residents, in line with these recommendations. The results from this study showed that most aged care facilities did not consistently receive and/or use this information at discharge from hospital. The findings also show that almost 20% of the facilities do not use digital medicine management systems. The Royal Commission into Aged Care report recommended aged care providers should use digital care management systems due to traditional paper-based methods being outdated and inefficient. Inconsistency in medicine information increases the risk of medication error and the likelihood of adverse outcomes. In the evolving landscape, pharmacists are in a key position to improve transfer of medicine information and judicious use of medicines, particularly with a move towards embedding pharmacists in RACFs. Strengths and weaknesses Limitations to this study include a small sample size of 31 completed surveys in one geographical area however this was 58.5% of all listed RACFs within the region and captured 80% of the banner organisations who operate under the same procedures. Experience and role of the responding participant likely impacted responses. As the respondents estimated the percentage of time they had received information from hospitals recall bias could have affected the accuracy of the data. Further Research Further research is required to explore the inconsistency in medicines information and communication at discharge from hospital for this vulnerable population to inform strategies to address shortcomings. CONCLUSION This study provides insight to medicines management processes and the variation that exists between RACF across a metropolitan area, highlighting the need for ongoing work to improve transfer of care to optimise safety. The findings also indicate that further research is required to determine best processes required to translate findings into action. While a variety of medicines related processes have been identified in this study, further discussion is warranted to gain a greater understanding of how the existing systems affect medicines management during transfer of care to and from the hospital to RACF. Declarations ACKNOWLEDGEMENTS We would like to extend our gratitude to the research funding bodies and participants for providing valuable insights for this research. FUNDING GCHHS Allied Health Clinical Governance, Education and Research unit provided clinical backfill funding to support this research. Acknowledgements The authors acknowledge the participants who participated in this study. The authors also acknowledge Gold Coast Allied Health Research for clinical backfill funding. Conflicts of interest statement The authors declare no conflicts of interest. Authorship statement Conceptualisation: RR, LH; Data collection: SB; Data analysis: SB, RR, LH; SB wrote the paper with input from all authors; All authors approved the final manuscript and have read and agreed to the published version of the manuscript. Ethics statement Ethics approval was received from GCHHS Human Research Ethics Committee (HREC/2021/QGC/70705). Data Sharing Statement De-identified datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Indicator metadata registry details. World Health Organization. 2020. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/percentage-of-older people-receiving-long-term-care-at-a-residential-care-facility-and-at-home Accessed: 19 March 2024. Older, Australians. Aged care. Australian Institute of Health and Welfare. 2021. https://www.aihw.gov.au/reports/older-people/older-australians/contents/aged-care Accessed: 02 June 2023. Lee H, Baek YH, Kim JH, et al. Trends of polypharmacy among older people in Asia, Australia and the United Kingdom: a multinational population-based study. Age Ageing. 2023;52(2):14. Jokanovic N, Tan ECK, Dooley MJ, et al. Why is polypharmacy increasing in aged care facilities? The views of Australian health care professionals. J Eval Clin Pract. 2016;22(5):677–82. Page AT, Potter K, Naganathan V, et al. Polypharmacy and medicine regimens in older adults in residential aged care. Arch Geronto Geriatr. 2023;105:104849. Lemoyne SE, Herbots HH, De Blick D, et al. Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC Geriatr. 2019;19(1):17. Putrik P, Grobler L, Lalor A, et al. Models for delivery and co-ordination of primary or secondary health care (or both) to older adults living in aged care facilities. Cochrane Database Syst Rev. 2021;3CD013880. https://doi.org/10.1002/14651858.CD013880 . Kosari S, McDerby N, Thomas J et al. Quality use of medicines in aged care facilities: A need for new models of care. J Clin Pharm Ther. 2018 (10):591–3. Price S, Holman C, Sanfilippo F et al. Are high-care nursing home residents at greater risk of unplanned hospital admission than other elderly patients when exposed to Beers potentially inappropriate medications? Geriatr Gerontol Int. 2014 (14):934–94. Algenae FA, Steinke D, Keers RN. Prevalence and nature of medication errors and medication-related harm following discharge from hospital to community settings: A systematic review. Drug Saf. 2020;43(6):517–37. Royal Commission into Aged Care Quality and Safety. Final Report 2021. https://agedcare.royalcommission.gov.au/publications/final-report Accessed 10 April 2024. von Elm E, Altman DG, Egger M et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Queensland Hospital Admitted Patient Data Collection QHAPDC APPENDIX A. 2018. https://www.health.qld.gov.au/__data/assets/pdf_file/0032/719780/appena-1819-v1.0.pdf Accessed 10 April 2023. Microsoft Corporation. (2018). Microsoft Excel . https://office.microsoft.com/excel . Australian Commission on Safety and Quality in Health Care. Clinical handover | Australian Commission on Safety and Quality in Health Care. https://www.safetyandquality.gov.au/our-work/communicating-safety/clinical-handover Accessed 20 Apr 2023. 16, Donaldson LJ, Kelley ET, Dhingra-Kumar N, et al. Medication Without Harm: WHO's Third Global Patient Safety Challenge. Lancet. 2017;389(10080):1680–1. Cite Share Download PDF Status: Published Journal Publication published 30 Sep, 2024 Read the published version in International Journal of Clinical Pharmacy → Version 1 posted Editorial decision: Minor revisions 18 Aug, 2024 Reviewers agreed at journal 22 Jul, 2024 Reviewers invited by journal 20 Jul, 2024 Editor invited by journal 20 Jul, 2024 Editor assigned by journal 20 Jul, 2024 First submitted to journal 20 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4769195","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":329531305,"identity":"6aeda0b5-5eeb-41c7-a2fc-3f42a2ff78b9","order_by":0,"name":"Sarah Browning","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0003-5776-8432","institution":"Gold Coast University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Browning","suffix":""},{"id":329531306,"identity":"ba26e9a4-6fd9-4d9e-b92d-24a42bf17e70","order_by":1,"name":"Rachael Raleigh","email":"","orcid":"","institution":"Gold Coast University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rachael","middleName":"","lastName":"Raleigh","suffix":""},{"id":329531307,"identity":"f84871f9-9a48-461a-b811-4f8b5db89fd7","order_by":2,"name":"Laetitia Hattingh","email":"","orcid":"","institution":"Gold Coast University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Laetitia","middleName":"","lastName":"Hattingh","suffix":""}],"badges":[],"createdAt":"2024-07-19 18:33:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4769195/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4769195/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11096-024-01801-2","type":"published","date":"2024-09-30T15:58:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":66097753,"identity":"dc3554bf-8b5c-4136-91e5-30b6f68030bb","added_by":"auto","created_at":"2024-10-07 16:15:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":702570,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4769195/v1/7f4d8b1a-5ccb-4120-a423-1c2532c18b9e.pdf"}],"financialInterests":"","formattedTitle":"Medicine communication from hospital to residential aged care facilities: a cross-sectional survey of aged care facility staff","fulltext":[{"header":"Impact of findings on practice statements","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eMedicine handover information from hospital is not consistently received by aged care facilities at discharge from hospital\u003c/li\u003e\n \u003cli\u003eA variety of practices and processes around medication management exist within aged care facilities\u003c/li\u003e\n \u003cli\u003eFurther exploration is required to determine barriers and facilitators impacting quality medicine management at transfer of care to aged care facilities\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eInternationally, there is an increase in the proportion of older persons [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and it is estimated that the number of people aged 60 years and older worldwide will increase from 1\u0026nbsp;billion in 2019 to 1.4\u0026nbsp;billion by 2030 and 2.1\u0026nbsp;billion in 2050. Australian 2020 data showed there were approximately 4.2\u0026nbsp;million older Australians (aged\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;65), comprising 16% of the totalpopulation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Older people often have co-morbidities with increased prevalence of polypharmacy, medication-related problems and hospital admissions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].An estimated 245,000 Australian people permanently lived in a residential aged care facility (RACF) between 2019 and 2020 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdmission to and discharge from hospital is known to be a high-risk period for medication-related harm especially for the older population [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Research shows that 91% of aged care residents take at least five regular medicines and 65% take more than 10 regular medicines daily and 18% of unplanned hospital admissions for aged care residents are a result of inappropriate medicine use[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].Quality medicines communication and handover is therefore vital during transfer of care to facilitate safe care and avoid medication errors or missed doses [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The 2021 Australian Royal Commission into Aged Care report raised the need for improvements at interfaces of care, including the provision of clinical information from residences to hospitals and vice versa [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and an up-to-date summary of health status and current medications.\u003c/p\u003e \u003cp\u003eA need was identified to explore the medicine handover and management during transfer of care to RACFs from two public hospitals in a metropolitan region. RACFs are spread across the region over approximately a 40km radius.\u003c/p\u003e"},{"header":"AIM","content":"\u003cp\u003eThe aim of this study was to explore medicine management practices at RACFs during transfer of care from hospital and staff experiences with medicines information handover.\u003c/p\u003e"},{"header":"ETHICS APPROVAL","content":"\u003cp\u003e Ethics approval\u003c/strong\u003e was received from the Gold Coast Hospital and Health Service (GCHHS) Human Research Ethics Committee (HREC/2021/QGC/70705).\u003c/p\u003e \u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003eCross-sectional survey methodology was used through an online questionnaire to explore practices and staff experiences in relation to the communication of medicines information at transfer of care from hospital. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSetting\u003c/h2\u003e \u003cp\u003eGCHHS is a tertiary service within a metropolitan region, providing care to a population of 625,087 people. At discharge from hospital, a RACF resident ideally receives an Electronic Discharge Summary (EDS), supply of newly prescribed or changed medicine, an Interim Medication Administration Record (IMAR) and if returning to RACF from the emergency department an Emergency Department Discharge Medication Administration Record (EDDMAR). Provision of this information is a state-based initiative in Queensland, Australia. Other states and territories in Australia have variations of these documents.\u003c/p\u003e \u003cp\u003eIn Australia, RACFs are approved by the Australian Government and managed by companies, charities, and other not-for-profit groups. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Some organisations manage multiple facilities, referred to as banner organisations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire Development\u003c/h2\u003e \u003cp\u003eThe questionnaire comprised 23 questions divided into three sections capturing facility profile (4 questions), clinical handover procedures (7 questions) and medicine management processes (12 questions). Following face and content validation by hospital pharmacists, a nurse practitioner specialising in aged care, medical practitioner, nurse and clinical trial co-ordinator, and senior pharmacy academic, some questions were modified. The questionnaire was formatted into MS Form and pilot tested by three pharmacists and a nurse to ensure flow and accuracy. An electronic link was incorporated into an email sent to RACFs with the participant information sheet.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Selection\u003c/h2\u003e \u003cp\u003eFifty-seven facilities were listed within the region as RACFs in Appendix 12 of the state Health Facilities list representing 26 banner organisations [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Upon initial contact, four of the listed facilities were no longer operating and excluded. The 53 RACFs were contacted via telephone to obtain an email address for the facility representative considered most appropriate to answer workload-related medicines questions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eAn email invitation was sent February 2022 with a study information sheet that explained completion of the questionnaire was regarded as complied consent; the questionnaire remained open until April 2022. There were two follow up telephone calls and emails to non-respondents. The questionnaire was completed by respondents online or over the telephone with a member of the research team entering responses with time automatically recorded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eQuestionnaire data was tabulated using Microsoft Excel\u0026copy; [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] to summarise participants\u0026rsquo; demographic and facility profile details, medicine handover from hospitals and medicine management procedures, including descriptive statistics with frequencies and percentages.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eIn total 31/53 (58.5%) responses were received representing\u0026thinsp;\u0026gt;\u0026thinsp;80% of banner RACFs within the region. The average duration to complete 30 of the questionnaires was 8.2 mins (SD\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.1). One was left open for an extended period and the duration therefore not included.\u003c/p\u003e \u003cp\u003eFour care managers, five clinical managers, 11 clinical care co-ordinators, two directors of care, two clinical leads, six registered nurses and one service manager completed the questionnaire (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Facility size varied between \u0026lt;\u0026thinsp;50 and 150\u0026ndash;200 residents with most facilities accommodating between 50\u0026ndash;100 residents. Multiple levels of care were offered by 87.1% of facilities; 18.5% offered independent living.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and facility profile information (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRespondent position\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eService manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHead of care/Director of care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical lead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCare manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical care co-ordinator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegistered nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of residents at facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100\u0026ndash;150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150\u0026ndash;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOffer varying levels of care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eLevels of care offered. Respondents selected all that apply (n\u0026thinsp;=\u0026thinsp;27)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePalliative care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent living\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDementia care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePermanent care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRespondents estimated the percentage of time (rounded to the nearest 10%) they received medicines handover information in the previous six months: Almost half (14/31; 48.4%) indicated they received a pharmacist generated IMAR for every resident transfer and 87.1% (27/31) stated they used the IMAR for medicine management at transfer (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Medicine communication via discharge summaries were less frequently reported with only 32.3% (10/31) stating they always received a discharge summary. Only 35.5% (11/31) reported they were familiar with the EDDMAR with 90.9% (10/11) familiar \u003cem\u003ewould\u003c/em\u003e use an EDDMAR if it were provided.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMedicine communication and management processes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePercentage of time IMAR received\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e48.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e9.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e16.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e9.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWill facility use the IMAR?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e87.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e9.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow often is a discharge summary received?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e32.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e16.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e16.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e12.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you know what the EDDMAR is?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e35.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e64.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHave you received an EDDMAR? (n\u0026thinsp;=\u0026thinsp;11)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e45.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e54.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHow often do you receive an EDDMAR? (n\u0026thinsp;=\u0026thinsp;5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvery 3\u0026ndash;4 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e60.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvery month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e40.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhich supply pharmacy do you use?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLocal community pharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e29.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLarger regional company\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e35.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHospital based service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e25.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of medicine administration chart used\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eElectronic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e35.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePaper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e19.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e45.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhich medicines aid do you use? Multiple selection option question\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBlister/bubble\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e48.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSachet system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e87.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCompartmentalised plastic boxes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAutomated medicines dispensing device\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you have an Imprest?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you routinely use the Imprest?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e67.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e32.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIf a resident is discharged does the hospital need to supply medicines?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e83.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e16.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow can staff administer medicines? Respondents to select all that apply\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUsing IMAR and labelled medicines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e93.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrom a pharmacist labelled medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e51.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrom a hospital medicines chart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e83.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrom a dose administration aid (DAA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e54.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCan staff make temporary changes to a webster pack?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e64.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e35.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you have an error reporting system\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e93.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe third section of the questionnaire outlined a wide variety of processes used for current medicines management (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A range of supply pharmacies were utilised including local ones and larger companies based outside of the region. A diverse arrangement of medicine administration recording systems were used with 6/31 (19.4%) using paper only. Dose Administration Aids were used in all but one facility. Many facilities used multiple forms of administration aids, with 27/31 (87.1%) using sachet systems, and 15/31 (48.4%) using blister or bubble packs. Most facilities had a supply of medicines available for emergencies such as the initiation of antibiotics however they were not routinely used with the first option to contact a pharmacy for supply.\u003c/p\u003e \u003cp\u003eFacilities reported varied processes for medicine management. Most facilities 26/31 (83.9%) required hospitals to supply medicines when patients are discharged. With respect to continuing medicines and administration of medicines from hospital documentation provided, processes in place differed between facilities with 2/31 (6.5%) reporting not administering from hospital supplied records (e.g., IMAR provided). These facilities required all administration systems to be updated by the facility doctor and/or pharmacy before implementing changes to the resident\u0026rsquo;s medicine. Most facilities (20/31; 64.5%) would make required adjustments without pharmacy involvement while 11/31 (35.5%) required their community pharmacy to repack the administration aid before use.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatement of key findings and interpretation\u003c/h2\u003e \u003cp\u003eStudies have highlighted that transition of care between hospital and RACFs is a high-risk time for medication-related harm [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Consistent and clear medicine handover information is vital for safe transitions of care. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Findings from this study showed there are varied processes and procedures at facilities when patients are transferred from hospital which could compromise patient care.\u003c/p\u003e \u003cp\u003eThe Australian Commission on Safety and Quality guidelines detail comprehensive clinical handover requirements at transfer of care between hospitals and RACFs [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A key clinical handover principle is clear and accurate communication of relevant and current patient information, including a current medicines list.\u003csup\u003e12\u003c/sup\u003e The World Health Organisation\u0026rsquo;s third Global Patient Safety Challenge similarly highlights the need for quality medicine handover during transitions of care [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Discharge summaries and medication records incorporate essential information for aged care residents, in line with these recommendations.\u003c/p\u003e \u003cp\u003eThe results from this study showed that most aged care facilities did not consistently receive and/or use this information at discharge from hospital. The findings also show that almost 20% of the facilities do not use digital medicine management systems. The Royal Commission into Aged Care report recommended aged care providers should use digital care management systems due to traditional paper-based methods being outdated and inefficient.\u003c/p\u003e \u003cp\u003eInconsistency in medicine information increases the risk of medication error and the likelihood of adverse outcomes. In the evolving landscape, pharmacists are in a key position to improve transfer of medicine information and judicious use of medicines, particularly with a move towards embedding pharmacists in RACFs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and weaknesses\u003c/h2\u003e \u003cp\u003eLimitations to this study include a small sample size of 31 completed surveys in one geographical area however this was 58.5% of all listed RACFs within the region and captured 80% of the banner organisations who operate under the same procedures. Experience and role of the responding participant likely impacted responses. As the respondents estimated the percentage of time they had received information from hospitals recall bias could have affected the accuracy of the data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFurther Research\u003c/h2\u003e \u003cp\u003eFurther research is required to explore the inconsistency in medicines information and communication at discharge from hospital for this vulnerable population to inform strategies to address shortcomings.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study provides insight to medicines management processes and the variation that exists between RACF across a metropolitan area, highlighting the need for ongoing work to improve transfer of care to optimise safety. The findings also indicate that further research is required to determine best processes required to translate findings into action. While a variety of medicines related processes have been identified in this study, further discussion is warranted to gain a greater understanding of how the existing systems affect medicines management during transfer of care to and from the hospital to RACF.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to extend our gratitude to the research funding bodies and participants for providing valuable insights for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;GCHHS Allied Health Clinical Governance, Education and Research unit provided clinical backfill \u0026nbsp;funding to support this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the participants who participated in this study. The authors also acknowledge Gold Coast Allied Health Research for clinical backfill funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest statement\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship statement\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConceptualisation: RR, LH; Data collection: SB; Data analysis: SB, RR, LH; SB wrote the paper with input from all authors; All authors approved the final manuscript\u0026nbsp;and have read and agreed to the published version of the manuscript.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics approval was received from GCHHS Human Research Ethics Committee (HREC/2021/QGC/70705). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Sharing Statement\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDe-identified datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eIndicator metadata registry details. World Health Organization. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/data/gho/indicator-metadata-registry/imr-details/percentage-of-older people-receiving-long-term-care-at-a-residential-care-facility-and-at-home\u003c/span\u003e\u003cspan address=\"https://www.who.int/data/gho/indicator-metadata-registry/imr-details/percentage-of-older people-receiving-long-term-care-at-a-residential-care-facility-and-at-home\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed: 19 March 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlder, Australians. Aged care. Australian Institute of Health and Welfare. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aihw.gov.au/reports/older-people/older-australians/contents/aged-care\u003c/span\u003e\u003cspan address=\"https://www.aihw.gov.au/reports/older-people/older-australians/contents/aged-care\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed: 02 June 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee H, Baek YH, Kim JH, et al. Trends of polypharmacy among older people in Asia, Australia and the United Kingdom: a multinational population-based study. Age Ageing. 2023;52(2):14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJokanovic N, Tan ECK, Dooley MJ, et al. Why is polypharmacy increasing in aged care facilities? The views of Australian health care professionals. J Eval Clin Pract. 2016;22(5):677\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePage AT, Potter K, Naganathan V, et al. Polypharmacy and medicine regimens in older adults in residential aged care. Arch Geronto Geriatr. 2023;105:104849.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLemoyne SE, Herbots HH, De Blick D, et al. Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC Geriatr. 2019;19(1):17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePutrik P, Grobler L, Lalor A, et al. Models for delivery and co-ordination of primary or secondary health care (or both) to older adults living in aged care facilities. Cochrane Database Syst Rev. 2021;3CD013880. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/14651858.CD013880\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD013880\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKosari S, McDerby N, Thomas J et al. Quality use of medicines in aged care facilities: A need for new models of care. J Clin Pharm Ther. 2018 (10):591\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrice S, Holman C, Sanfilippo F et al. Are high-care nursing home residents at greater risk of unplanned hospital admission than other elderly patients when exposed to Beers potentially inappropriate medications? Geriatr Gerontol Int. 2014 (14):934\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlgenae FA, Steinke D, Keers RN. Prevalence and nature of medication errors and medication-related harm following discharge from hospital to community settings: A systematic review. Drug Saf. 2020;43(6):517\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoyal Commission into Aged Care Quality and Safety. Final Report 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://agedcare.royalcommission.gov.au/publications/final-report\u003c/span\u003e\u003cspan address=\"https://agedcare.royalcommission.gov.au/publications/final-report\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 10 April 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evon Elm E, Altman DG, Egger M et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQueensland Hospital Admitted Patient Data Collection QHAPDC APPENDIX A. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.health.qld.gov.au/__data/assets/pdf_file/0032/719780/appena-1819-v1.0.pdf\u003c/span\u003e\u003cspan address=\"https://www.health.qld.gov.au/__data/assets/pdf_file/0032/719780/appena-1819-v1.0.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 10 April 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMicrosoft Corporation. (2018). \u003cem\u003eMicrosoft Excel\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://office.microsoft.com/excel\u003c/span\u003e\u003cspan address=\"https://office.microsoft.com/excel\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Commission on Safety and Quality in Health Care. Clinical handover | Australian Commission on Safety and Quality in Health Care. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.safetyandquality.gov.au/our-work/communicating-safety/clinical-handover\u003c/span\u003e\u003cspan address=\"https://www.safetyandquality.gov.au/our-work/communicating-safety/clinical-handover\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 20 Apr 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e16, Donaldson LJ, Kelley ET, Dhingra-Kumar N, et al. Medication Without Harm: WHO's Third Global Patient Safety Challenge. Lancet. 2017;389(10080):1680\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"transition of care, medicine handover, medication-related harm, hospital pharmacy, aged care facility, geriatric medicine management","lastPublishedDoi":"10.21203/rs.3.rs-4769195/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4769195/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Continuity of medicines management can be compromised when older people are transferred between hospital and residential aged care facilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e: This study explored medicine management practices at facilities during patients’ transfer of care from hospital, and staff experiences with medicines information handover from hospitals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: An electronic cross-sectional questionnaire sent to all residential aged care facilities within a metropolitan region, February to April 2022. The survey comprised 23 questions covering facilities’ profiles, medicines management practices, and medicine management at transfer of care from hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Of 53 listed facilities, thirty-one (58.5%) responded representing \u0026gt; 80% banner organisations. Facilities varied in size ranging between \u0026lt; 50 and 200 beds. A variety of services were provided with 87.1% offering more than one level of care. Responses indicated differences in medicines management processes with 19.4% solely using hardcopy medication charts. Handover from hospitals to manage patients’ medicines at transfer was inconsistent with only 48.4% reporting consistently receiving appropriate documentation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Diverse processes and practices exist for medicines management in residential aged care facilities for routine activities and when residents transfer from hospital to facilities. Medicine communication received from hospital during discharge to a facility varies considerably, potentially compromising patient safety and care.\u003c/p\u003e","manuscriptTitle":"Medicine communication from hospital to residential aged care facilities: a cross-sectional survey of aged care facility staff","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-14 14:07:39","doi":"10.21203/rs.3.rs-4769195/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revisions","date":"2024-08-18T06:04:34+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2024-07-22T16:11:35+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-20T14:35:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"International Journal of Clinical Pharmacy","date":"2024-07-20T14:20:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-20T08:13:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Clinical Pharmacy","date":"2024-07-20T07:44:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b0b9c145-b9a6-42b3-a748-261f8ce17c6b","owner":[],"postedDate":"August 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-07T16:12:49+00:00","versionOfRecord":{"articleIdentity":"rs-4769195","link":"https://doi.org/10.1007/s11096-024-01801-2","journal":{"identity":"international-journal-of-clinical-pharmacy","isVorOnly":false,"title":"International Journal of Clinical Pharmacy"},"publishedOn":"2024-09-30 15:58:26","publishedOnDateReadable":"September 30th, 2024"},"versionCreatedAt":"2024-08-14 14:07:39","video":"","vorDoi":"10.1007/s11096-024-01801-2","vorDoiUrl":"https://doi.org/10.1007/s11096-024-01801-2","workflowStages":[]},"version":"v1","identity":"rs-4769195","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4769195","identity":"rs-4769195","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}