Are medications safely used by residents in elderly care homes? – A multi-centre observational study from Sri Lanka

Abstract

Background Most residents in elderly care homes in Sri Lanka do not receive formal, on-site, patient care services. Objective To evaluate the appropriateness of prescribing, dispensing, administration, and storage practices of medication used by residents in selected elderly care homes in Colombo District, Sri Lanka. Methodology This was a prospective, cross-sectional, multi-center study of 100 residents with chronic, non-communicable diseases, who resided in nine selected elderly care homes in Sri Lanka. Medication histories were obtained from each resident/caregiver and the appropriateness of medications in their current prescription was reviewed using standard treatment guidelines. Prescriptions were cross-checked against respective dispensing labels to identify dispensing errors. Medication administration was directly observed on two separate occasions per resident for accuracy of administration, and matched against the relevant prescription instructions. Medication storage was also observed in terms of exposure to temperature and sunlight, the suitability of container, and adequacy of separation if using multiple medications. Results The mean age of residents was 70±10.5 years and the majority were women (72%). A total of 168 errors out of 446 prescriptions were identified. The mean number of prescribing errors per resident was 1.68±1.23 [median, 2.00 (1.00-3.00)]. Inappropriate dosing frequencies were the highest (37.5%;63/168), followed by missing or inappropriate medications

Patterns of Medication Errors Involving Older Adults Reported to the French Medication Error Guichet

“…Furthermore, we considered patients 60 years and older as older adults. This is an existing [41][42][43][44] but less common categorization. Other ME studies use the 65 years and older threshold to define older adults.…”

Societal Narratives on Caregivers in Asia

“…In the rare instances that caregivers are discussed, narratives centre mostly on institutional care as well as caregiver burden. Although the family has historically been the mainstay of care [ 26 ], higher levels of migration among younger family members have led more to send their aging parents to long-term care facilities [ 27 ].…”

“…The long-term care facilities in Sri Lanka that do exist suffer from a severe shortage of qualified and trained healthcare staff. This has led to a prevalence of errors in the prescription, administration and storage of medication—errors which untrained caregivers are unable to detect [ 27 ]. It is therefore a major cause for concern that the topic of training caregivers accounts for only a tiny fraction of the narratives.…”

“…In this respect, the substandard quality of long-term care facilities in Sri Lanka can be looked to as a cautionary tale. Ensuring that caregivers are adequately trained will prevent older adults’ existing health conditions from being exacerbated by errors in prescribing or dispensing medication as have occurred in Sri Lanka [ 27 ].…”

The Sri Lankan Perspective of Implementing Clinical Pharmacy Services

“…The idea that errors cannot happen is a clear indication of a poor safety culture in the healthcare system in Sri Lanka. There are ample evidences on lapses in the medication use process to justify that an additional safety net is needed to overcome this problem [11,12,13,14,15,16]. If there are trained pharmacists to deliver clinical pharmacy services in Sri Lanka, then suppressing this process is a deprivation of human rights.…”