Making sure the residents get their tablets: medication administration in care homes for older people

This paper reports an exploratory study of issues concerning the nursing practice of altering medication dose forms prior to administration of medicines to residents in homes for older people.

Medication use and administration is a major issue in residential homes for older people. Research suggests that the alteration of medication dose forms in these homes is a widespread practice. Despite its prevalence, there is limited nursing or pharmaceutical literature exploring the decision-making processes surrounding this practice, the methods by which medicines are altered, or the types of medicines which are modified.

Semi-structured interviews were carried out with 11 Registered Nurses working in a purposive sample of 10 residential homes for older people drawn from each of the six regions of South Australia. The data were collected in 2000.

Nurses felt constrained to ensure that prescribed medication was administered to residents, despite their concern that this was not without risk. Nurses were concerned that they were working in an information vacuum, due to limited information resources and informal communication with other healthcare professionals such as speech pathologists, pharmacists and general practitioners. There was also concern about the difficulty of coordinating information and policies about altering medications and of implementing appropriate procedures in individual facilities.

Clinical guidelines for the processes surrounding the alteration of medication dose forms and relevant pharmaceutical information are needed in all residential homes for older people. Ongoing education for nurses in this area is also required.