The challenges of maintaining consistent medication during transitions from hospitals to residential aged-care facilities (RACFs) are significant and concerning. Recent research has uncovered alarming gaps in the processes involved in these transitions, revealing that nearly 25% of patients experience missed or delayed doses of their medications.
Led by Adjunct Associate Professor Rohan Elliott from the Pharmacy Department at Austin Health, a comprehensive review was conducted involving 397 patients across 11 hospitals in Victoria. This study looked at the patients just two days after their discharge, and the results were telling: 23% of these individuals had at least one instance of either a missed or significantly delayed medication dose. Alarmingly, 5% of patients neglected high-risk medications—such as opioids, anticoagulants, levodopa, and insulin—while 13% faced issues with moderate-risk medications, which include antimicrobials and non-opioid pain relievers.
Interestingly, the research indicated that the risk of these missed or delayed doses could be mitigated when hospitals provided discharge medications in their original packaging along with an interim medication administration chart (IMAC). Furthermore, when community pharmacies delivered repackaged medications on the actual day of discharge, the occurrence of such risks decreased.
Despite these findings, only about half (52%) of the patients had their medication charts for aged care prepared or updated during the transfer process. Additionally, only 46% received their updated medications from community pharmacies, which were packed in dose administration aids (DAAs).
A particularly noteworthy finding was that if a general practitioner or locum prepared the RACF medication charts on the day of discharge, it actually increased the likelihood of missed or delayed doses. This may be attributed to the fact that GPs are often unavailable until later in the day, leading to gaps in care.
The researchers advocate for hospitals to adopt the use of IMACs actively, facilitating timely and safe medication administration. They also urge that RACFs be encouraged to use these charts routinely to streamline the medication process.
However, the study highlights a troubling lack of clear guidance and support from both state and Commonwealth governments, as well as from health and aged care safety organizations, regarding the use of IMACs. The absence of standardized procedures for IMACs is seen as a significant obstacle to their widespread adoption.
Given that there is typically less than three hours between patient discharge and the first required medication dose, the team recommends that hospitals should be enabled to provide up to seven days' worth of interim medications, coordinated with a seven-day IMAC. This approach could greatly improve the continuity of medication administration and reduce the risk of errors.
In conclusion, the research calls for addressing the barriers that hinder the implementation of these recommended practices. For those interested in exploring the complete details of this study, the full paper is available HERE (https://bpgclick.com/pd/2?Yz0xMDAmdGR1dG1fc291cmNlPXBkZiZ0ZHV0bV9tZWRpdW09cGRmJnRkdXRtX2NhbXBhaWduPVBEMTAwMjI2JnU9aHR0cHM6Ly9jb25uZWN0c2NpLmF1L3B5L2FydGljbGUtYWJzdHJhY3QvMzIvMS9QWTI1MjU2LzI2NzU5Mi9GYWN0b3JzLWFzc29jaWF0ZWQtd2l0aC1jb250aW51aXR5LW9mLW1lZGljYXRpb24=).
This article was featured in the recent issue of Pharmacy Daily dated February 10, 2026. To read the entire newsletter, you can view the embedded issue below or CLICK HERE to download Pharmacy Daily from February 10, 2026 (https://issues.pharmacydaily.com.au/2026/Feb26/pd100226.pdf).
