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To explore how residents and caregivers experience engagement in medication communication during transitions of care.
Qualitative exploratory study.
Nine residents and seven family caregivers from two rural aged care homes participated in semi-structured interviews between June and July 2024. Engagement in medication communication was assessed using the Patient and Family Engagement Framework. The COREQ checklist guided reporting of the study.
The study identified two main themes: (1) Medication communication during transitions into healthcare services; (2) Influences shaping residents' and caregivers' engagement in medication communication. Participants primarily experienced passive consultation about medications, mainly due to a lack of proactive engagement from healthcare providers, with both intrinsic and external factors significantly hindering their involvement in medication communication.
Participants had minimal engagement in medication communication during transitions, receiving mainly reactive, one-way information from providers. Improved communication strategies and greater involvement of residents and caregivers are needed to enhance medication safety and continuity of care in rural settings.
This study provides insights into medication communication engagement among rural aged care residents and their family caregivers. By applying the Patient and Family Engagement Framework, the findings highlight the need for proactive, clear and inclusive communication strategies to enhance medication safety and continuity of care. Improving engagement in medication discussions can support shared decision-making, reduce misunderstandings and improve transitions of care in rural aged care settings.
The study followed COREQ guidelines.
Residents and family caregivers participated through interviews.
To explore which regularly prescribed medications are most commonly administered to older adults in aged care facilities in Australia, by whom and when, and to identify the prevalence of polypharmacy in this population group.
Retrospective descriptive study.
This study involved exploratory analysis of de-identified medication administration records from March 17, 2023–March 18, 2024. Older adults' demographic and medication administration data were requested from two electronic medication chart providers in Australia. For inclusion, older adults must have been living in an aged care facility for the entire timeframe. Data were analysed using descriptive statistics, activity pattern analysis, Welch two sample t-tests, ANOVA and independent sample t-tests. The STROBE checklist was used to report this study.
In all, 12,438 older adults were included, with a median age of 87, spanning 287 aged care facilities across Australia. Nervous system medications (over 16 million doses) and alimentary tract/metabolism medications (over 12 million doses) were the most administered. Within these, paracetamol 500 mg tablets and docusate sodium 50 mg + sennoside B 8 mg tablets were the most common. Quetiapine, a strong anticholinergic medication, was also present in the top 30 most administered medications. Certified nursing staff were the primary administrators of medication (66% of actions), followed by non-nursing staff (27%). Medications were predominantly administered before 10 am and after 10 pm. With a median of 8 regular medications administered per older adult per day, 78% experienced polypharmacy.
The most common regular medications administered in aged care facilities were non-opioid analgesics and laxatives. Many medications were administered in the late evening, where staffing levels were likely to be limited. There was a high prevalence of polypharmacy, and non-nursing staff were involved in medication administration.
This study offers important insights and new knowledge around use of regular medications in aged care facilities, using a nationally representative sample from Australia. It highlights the high volume of non-opioid analgesics and laxatives administered to older adults, some of which may be optimised, modified or replaced with nonpharmacological alternatives to reduce medication burden. This study also notes that not all regular medications are being administered in Australia by certified nursing staff, and that medication administration activity peaks during both breakfast and late evening rounds. These are important considerations for aged care facilities when assessing staffing ratios, rostering, and how to reduce competing demands for aged care staff. Although much attention has been placed on reducing polypharmacy and optimising medications for older adults, this study also identifies that polypharmacy is prevalent, with 78% of older adults experiencing this through use of regular medications alone. The findings of this study will enable more informed discussions between nursing staff, prescribers, pharmacy and potentially older adults and their families around regular medication and its administration in aged care facilities.
The STROBE checklist was followed.
No patient or public contribution.
To explore the experiences and perceptions of communication about managing medication across transitions of care for residents living in aged care homes and their family caregivers.
Effective medication communication across transitions of care involves exchanging information, resident, and family caregiver's participation in decision-making, and shared responsibility.
A qualitative meta-synthesis.
This review was conducted in accordance with the PRISMA 2020 guidelines and the accompanying 27-item checklist. A systematic search of seven electronic databases (Embase, PsycINFO, Medline Ovid, Scopus, CINAHL, EmCare and Web of Science) was performed from inception to December 2023. Studies eligible for inclusion in this review were required to be published in peer-reviewed English journals and focus on medication communication among healthcare providers, residents and family caregivers during transitions of care for aged care residents. The JBI Critical Appraisal Checklist for Qualitative Research was employed for the critical appraisal of the studies, and the COREQ checklist was used to evaluate their quality.
Of the 2610 studies identified, 12 met the inclusion criteria. No study was excluded based on quality. Two main themes were generated: (1) Medication information exchange involving residents and families, and (2) resident and family factors influencing medication communication engagement. The findings revealed a lack of supportive structure for effective communication and collaboration among residents, family caregivers and healthcare providers during transitions of care, marked by one-way interactions and limited evidence of shared decision-making or family caregiver engagement in medication management communication, despite varying individual needs and preferences.
Communication about medication management during transitions of care focused on sharing details rather than active engagement. Residents and their family caregivers have individual needs and perspectives regarding communication about medication management, which are not well addressed by healthcare providers during transitions of care. Healthcare providers' communication remains limited, and family caregivers are underutilised.
To investigate the ways that nurses engage with referral letters and discharge summaries, and the qualities of these documents they find valuable for safe and effective practice.
This study comprised a qualitative, case-study design within a constructivist paradigm using convenience sampling.
Interviews were conducted with nurses to investigate their practices relating to referral letters and discharge summaries. Data collection also involved nurses' examination and evaluation of a diverse range of 10 referral letters and discharge summaries from medical records at two Australian hospitals through focus-group sessions. The data were transcribed and analysed inductively.
In all, 67 nurses participated in interviews or focus groups. Nurses indicated they used referral letters and discharge summaries to inform their work when caring for patients at different times throughout their hospitalisation. These documents assisted them with verbal handovers, to enable them to educate patients about their condition and treatment and to provide a high standard of care. The qualities of referral letters and discharge summaries that they most valued were language and communication, an awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information.
Nurses relied on referral letters and discharge summaries to ensure safe and effective patient care. They used these documents to enhance their verbal handovers, contribute to patient care and to educate the patient about their condition and treatment. They identified several qualities of these documents that assisted them in maintaining patient safety including clarity and conciseness of information.
It is important that referral letters and discharge summaries are written clearly, concisely and comprehensively because nurses use them as key sources of evidence in planning and delivering care, and in communicating with other health professionals in relaying goals of care and implementing treatment plans.
Nurses reported that they regularly used referral letters and discharge summaries as valuable sources of evidence throughout their patients' hospitalisation. The qualities of these documents which they most valued were language and communication styles, awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information. This research has important impact on the patient experience in relation to encouraging effective referral letter and discharge summary writing.
We have adhered to the relevant EQUATOR guidelines through the SRQR reporting method.
No patient or public contribution.
To explore collaborative practice and perceptions and attitudes of key stakeholders on collaboration in type 2 diabetes management in a tertiary care setting.
Understanding collaborative practice in diabetes care in developing countries helps to design and provide patient-centred and cost-effective care.
An exploratory qualitative study.
Interviews were undertaken with 30 patients and 18 health professionals and policymakers. Thematic data analysis was undertaken to explore collaborative practice and examine participant perspectives on collaboration in diabetes management. We compared the findings with D'Amour's Collaboration Framework to determine the level of collaboration.
Most participants reported a lack of collaborative practice in diabetes management, while they appreciated its importance in improving care. Perceptions varied with respect to what constituted collaborative practice. Three themes were identified: (1) perspectives of key stakeholders on current practice of collaboration; (2) impediments to collaborative practice; (3) strategies to improve collaborative practice. Analyses of the themes using D'Amour's Collaboration Framework indicated a low level of collaboration among physicians, nurses, pharmacists and policymakers, which was attributed to workload and time pressures on health professionals, power dynamics and lack of role clarity of all actors in collaborative action. Participants commented on the need to improve collaboration by establishing strong leadership and governance at different healthcare structure levels, which is committed to coordinating collaboration and developing collaborative frameworks and policies that guide collaborative undertaking.
Perceived shortcomings of collaboration were attributed to inadequate resources, power dynamics, a lack of strong team functioning and policies. Participants' positive perceptions provide an opportunity to improve collaborative practice through incorporation of collaborative frameworks and policies.
The findings in this study inform development of tailored and patient-centred diabetes care in tertiary care settings in sub-Saharan Africa.
The study was reported in accordance with the COREQ checklist.
Patients or the public were not involved in the design, analysis or interpretation of the data in this study. However, patients and healthcare providers participated in pilot interviews, which helped refine the interview guides. The summary of the findings of the study was also discussed with patients and healthcare providers, where they provided feedback.
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