Omission of regular medications in aged care facilities: a retrospective observational study

In aged care facilities, medications are typically administered to older adults by authorized aged care workers. Medication dose omissions may occur during this process, where a prescribed dose is not administered before the next scheduled dose time. Published research on medication dose omissions almost exclusively focuses on hospital settings, with dose omissions described as mistakes or a form of administration error. There is very little empirical evidence about medication dose omissions in aged care facilities, how they occur, the medications omitted, and why.

The aim of this study was to characterize medication dose omissions in the context of Australian aged care facilities, outlining the prevalence of omissions, most commonly omitted medications, omission categories, timing of omissions, and reasons behind medication dose omissions.

A retrospective observational study was conducted using de-identified secondary medication administration data from two national electronic medication chart providers, spanning from March 17th 2023 to March 18th 2024. All regular medication dose omission events over the timeframe were included. Data included resident demographics, aged care workers role permissions, and free-typed reasons and rationales aged care workers had recorded for each dose omission. Data were analyzed using descriptive statistics, independent sample t-tests, activity pattern analysis, and Spearman's correlation.

In total, 12,438 residents lived in aged care facilities during the timeframe, across 287 aged care facilities. Residents experienced a median of one dose omission per 100 doses dispensed (IQR 0.45-2.66). Certified nursing staff were the primary recorders of omitted doses (60 %). The Anatomical Therapeutic Chemical classifications most omitted were alimentary tract and metabolism medications (one dose omission per 26.84 doses), and nervous system medications (one dose omission per 53.65 doses). The most omitted medications included forms of paracetamol, laxatives, and lubricating eye drops. In all, 56 % of medication omission records lacked corresponding details about the factors or decision-making that led to the omission.

Regular medications were omitted, but inconsistently recorded in Australian aged care facilities. Standardization and education around managing and recording omissions may improve resident-centric medication administration in aged care facilities, better support aged care workers' clinical decision-making, and help to inform more nuanced medication reviews.