Topic: An evaluation of the medication modification practices in the Australian aged care facilities: Findings from video-recorded observations of medication rounds

Day: Thursday 22 October 2020

Time:  3:30pm-4:00pm AEDT


Background: Swallowing difficulties are a common problem affecting older people in aged care facilities (ACFs) and can compromise residents’ ability to take their medications orally. As a result, dosage forms of oral medications are frequently modified in ACFs by crushing/splitting tablets or opening capsules to facilitate medication administration for residents. However, there are safety concerns with such practices including adverse events resulting from loss of dose and alteration in the rate of absorption.
Aim: The aim of this study was to identify the prevalence, methods, and appropriateness of dosage form modification practices in ACFs.
Method: This study was conducted in a sample of four ACFs in Queensland. Video-recorded observations of medication preparation processes were carried out using an action camera placed on medication trolleys and reviewing videos after data collection. The incidence and appropriateness of dosage form modifications were determined by comparing each instance of dosage form modification against the recommendations in the existing national guideline of the Australian Don’t Rush to Crush Handbook.
Results: Overall, 810 instances of oral medication preparation were observed across 23 medication rounds. In 25.7% of medication preparation instances the dosage form of medication was altered. The most frequently modified medications were paracetamol (17.3%), metoprolol (10.1%), and sodium valproate (5.8%). The most common methods by which medications were altered included crushing tablets with a manual crushing device (71.6%), cutting/splitting tablets (20.2%), and opening capsules (3.8%). Of these, 12.5% of modification instances did not comply with the national guideline and were deemed inappropriate. Inappropriate practices were associated with suboptimal methods of medication preparation where medications were unsuitably modified, mixed, spilled, or incompletely dosed. Medication preparation took significantly longer for residents having at least one medication modified compared to those whose medications were not modified (115 ± 59 vs. 38 ± 41 seconds, p < 0.05).
Conclusion: Medication modification is a common practice in ACFs. Some of these modifications are inappropriate and may pose safety risks to both residents and healthcare workers. Healthcare workers in ACFs need to be supported with effective training and pharmacist medication reviews to promote the best and safest practices of dosage form modification.





Ayda is a pharmacist with clinical experience across different healthcare settings and currently works as an Associate Lecturer in Queensland University of Technology (QUT). Ayda’s research interests mainly focus on the Quality Use of Medicines and developing interventions to improve medication use in patients especially older people. Over the last years, Ayda has been involved in multiple research projects and has authored more than 15 articles in scholarly journals. She received her PhD degree from QUT in 2019. In her PhD, Ayda investigated the medication practices for aged care residents with dysphagia or swallowing difficulties, which led to the development of a set of recommendations to address the existing barriers and facilitators around these practices. Ayda’s PhD project has received recognition on several occasions and has secured research grants to provide training programs for aged care facilities regarding best and safest medication administration practices for residents with swallowing difficulties.