Objective: To audit the accuracy of dose administration aid (DAA) packaging in regional aged care facilities (RACFs) within the boundaries of the Hunter Urban Division of General Practice. Design, participants and setting: Each participating RACF audited one DAA for each resident receiving medication between May and August 2006. Registered nurses compared the contents with the medication chart prepared by the general practitioner and recorded any discrepancies as incidents. Main outcome measures: Number of medication incidents in the provision of DAAs. Results: 297 incidents were detected from 6972 packs for 2480 residents (incident rate of 4.3% of packs and 12% of residents) from 42 participating RACFs. Reasons for incidents included medications missing from a pack (99 occasions), wrong medication dispensed (12), supply of the wrong strength (32), incorrect labelling (7), pharmacies supplying medication that had been ceased by the GP (37), incorrect dosage instructions (32), medications not delivered to the RACF (13). Conclusion: The rate of incidents in DAA packaging in RACFs was high. The error types included incorrect packaging, correct packaging but the DAA was no longer required, and operational problems. Recommendations for improvement include: continuing audit and analysis by RACFs; streamlining of communications among GPs, pharmacists and RACF staff; using electronic methods to chart, order and dispense medications; use of generic names as much as possible; development of guidelines for the supply of medication in DAAs.

Objectives: To examine the effectiveness of anticoagulation among patients discharged from hospital on warfarin in the care of general practitioners (GPs). Design and setting: A historical cohort with questionnaires to patients discharged from a major metropolitan teaching hospital and their GPs. Participants: Patients discharged between 1 February 1995 and 31 January 1996 identified from hospital pharmacy records as being prescribed warfarin, and their treating GPs. Main outcome measures: Frequency of testing and levels of international normalised ratio of prothrombin time (INR) within six months of discharge; level of INR aimed at by GP; complication rates; and patient knowledge about anticoagulation. Results: Replies were received from 242 (68%) patients and pathology records were examined for 195 (81%) of these. The median gap between INR measures was seven days. The median of the median INR level for each patient was 2.4 (rising to 2.7 in patients with an artificial heart valve); 24% of observed patient time was spent at an INR level of less than 2.0, 54% between 2.0 and 2.9, 18% between 3.0 and 3.9 and 4% at an INR level of 4.0 or more. There were five confirmed major complications (equivalent to 5 per 100 patient‐years). Twenty‐seven per cent of patients answered at least eight of the 10 knowledge questions correctly: education level predicted knowledge, but there was no relationship between knowledge and INR level. Conclusions: Among this unselected group of patients whose anticoagulation was managed by GPs, there was a high frequency of laboratory testing, INR levels were controlled safely and complication rates were comparable with those in published reports.

In an increasingly informed society there has been a growing interest by consumers in evaluating the quality-of-care provided by their practitioners. This task is complicated by an asymmetry in the technical knowledge required to assess health-care quality between consumers and health providers. Recently attempts have been made to incorporate patient views into the assessment of quality to try and address this asymmetry. A number of quality initiatives have been developed to help provide consumers with markers of practitioner competency including professional training programmes and examinations, quality standards and quality assurance activities. International trends include federal funding for quality improvement activities within practices, and greater use of information technology to provide error warning systems for practitioners, to monitor practice patterns, and to promote better communication of information between health services. It is important in developing these new initiatives that 'symmetrical' approaches which capture consumers' views on quality are employed.