clinical focus
Objective gains
The path to an innovation in patients’
prescription charts began with a request for
proof of practice from the quality watchdog.
By Gerrard Stevens
O
bjective evidence. That’s the
phrase that became integral
to the Australian Aged Care
Quality Agency’s accreditation assessor
course in 2000.
Residential aged-care facilities
undergoing the qualification process
need objective evidence. Facilities have
to demonstrate with objective evidence
that they have quality improvement
strategies in place. And what is the
objective evidence that the policies and
procedures are understood and being
implemented by staff, and that residents
are not put at risk?
An innovation that supported this
need for objective evidence was the first
computer-generated medication chart,
which was initially developed for the James
Milson facility in North Sydney. At the time,
it was a revolutionary concept.
The advantage of a computer-generated
chart was the elimination of illegible doctors’
handwriting. It also offered an audit trail of
objective evidence, and a central source of
truth to which all involved in the medication
cycle could refer, further minimising the risk
of error.
34 agedcareinsite.com.au
The use of computer-generated
medication charts as the primary
documentation for doctors to sign, and
from which nurses administer, triggered
a question: why shouldn’t that document
be eligible as a pharmaceutical benefit
scheme prescription?
At the time, doctors not only had to
write up the primary chart, they also had
to write separate PBS prescriptions.
This represented a challenge for
doctors. PBS medication quantities do
not necessarily relate to a timeframe of
use. For example, tablets of furosemide,
a medication to treat fluid build-up, are
prescribed in a bottle of 100: 100 days’
supply if the dose is one a day, or 50 days’
supply if the dose is twice a day.
The situation is further complicated
when the frequency of doses is increased
or decreased halfway through the life of
the original prescription. Such variations
lead to complexity, and complexity can
lead to error and misadventure. How can
a doctor ever hope to monitor when new
prescriptions need to be written?
Another problem for pharmacists
delivering aged-care services was getting
the doctor to write prescriptions before
they needed dispensing.
This was an almost impossible task,
representing an extreme hidden cost.
Doctors and their patients depended on
the pharmacist doing the right thing and
continuing medication supply despite
the prescription being absent. Insisting
on the prescription b