Balancing beliefs about time, remuneration and quality outcomes
Purpose: This paper discusses the beliefs and assumptions that influence the use, and misuse, of medicines in residential aged care.
Methods: An action research study was conducted in a 90-bed residential aged care facility in metropolitan Melbourne, over a 12-month period. The findings from observation in the field and interviews with 51 participants: general practitioners, pharmacists, registered nurses, enrolled nurses, personal care assistants, residents, and relatives of cognitively impaired residents are reported.
Results: A number of competing beliefs were found to influence behaviours regarding the use of medicines. These beliefs included: get the medicines into the residents, because medicines can treat the symptoms/disease, quickly, so it for the resident’s own good, for which we have a legal accountability. Resulting behaviours included superficial assessment rather considering holistic care needs, lack of consultation with residents and other members of the multidisciplinary team, prescribing medicines rather than engaging the skills of appropriately qualified staff and allied health care professionals, coercive and covert administration of medicines, and continuing to prescribe medicines, even when residents were not taking them.
Conclusions: This paper argues that medication management behaviours are not always in the best interests of residents, and can cause harm. It is of concern that these beliefs and behaviours are not new, yet they continue to influence medication management practices. Health care professionals and consumers need to examine their beliefs and consider how their own actions may contribute to the misuse of medicines. A balance needs to be reached between time, remuneration, and quality outcomes for consumers.