December 30, 2009

NEW ZEALAND: Concern over rest homes' medicine use

. AUCKLAND, New Zealand / The Press / National / Health / December 30, 2009 By Rebecca Todd - The Press Nearly half of all rest homes audited over the past six months failed to meet required medicine management standards. In a damning report released this month, Auditor-General Lyn Provost said underperforming rest homes were not being properly followed up and improvement was slow. Auditors assess the services provided by rest homes and class results as continuous improvement, fully attained, partially attained or unattained. A Ministry of Health report released to The Press shows that between June and November this year, 44 per cent of 320 audits had at least one partial-attainment ranking for medicine management. Photo credit: Age Concern, New Zealand Problems were identified in areas such as safe and appropriate prescribing, dispensing, storage and disposal. Eight aged-care providers had four or more criteria partially attained and 13 had three partial attainments. Medicine management comes under the general category of "continuum of service delivery", which has 13 standards. In Canterbury, eight of the 17 rest homes that have audit reports available online have only a partial attainment in this area. Where a rest home fails to meet a standard it is supposed to submit progress reports to the ministry describing action taken to meet the criteria. Provost said rest homes sent the reports to their auditing agency, which forwarded them to the ministry, but progress was rarely independently verified. "Our reviews showed that [auditing agencies] largely rely on rest homes reporting their own progress," she said. "In the files we reviewed, the ministry accepted most progress reports and did not require the rest home to take any more action." This type of reporting was not always effective in ensuring that improvements were made, and rest homes were often continually failing in the same or closely related criteria, she said. "More than half of the rest homes in our sample received recurring partially attained ratings in one or more criteria," she said. "This indicates that progress reporting is not leading to sustained improvements." The report gave examples of auditors having failed to pick up lax standards of care. It said that in 2008 a complaint was laid about conditions in a rest home, including an oxygen-supply shortage. A district health board audit found serious failings with the medication management system, a failure to investigate errors and controlled-drug counts not adding up. The auditors had reported the medicine management criteria as fully attained. Canterbury District Health Board member Andrew Dickerson said it was concerning to see the same homes turning up in complaints. While most performed well, about 10 per cent had a pattern of complaints that required investigation, follow-up and monitoring, but this did not always happen, he said. A common complaint he heard from family members was the use of anti-psychotic drugs on their elderly relatives. Ministry of Health manager of quality and safety Rose Wall said medicine management was an important area. "There is clearly room for improvement, and better use of information from audit reports is a step towards improving this," she said. [rc] © 2009 Fairfax New Zealand Limited