Interventions to Enhance Medication Safety in Residential Aged Care
Settings: An Umbrella Review
Abstract
Aim: To conduct the first systematic synthesis of existing evidence
reviews on interventions to enhance medication safety in RACS, to
establish and compare their effectiveness. Method: This umbrella review
included examination of meta-analyses, scoping and systematic reviews.
Four electronic databases (MEDLINE, EMBASE, CINAHL, and The Cochrane
library database of Systematic Reviews) were explored for eligible
reviews. Those meeting the inclusion criteria were critically appraised
using the JBI Critical Appraisal Instrument for Systematic reviews and
Research Syntheses by two authors. Results: Fourteen reviews covering
166 unique, primary studies were included. Interventions were grouped
according to type: medication review (n= 12); staff education (n= 8);
multidisciplinary team meetings (n= 6); computerised clinical decision
support systems (n= 5); and transferring medicines information between
health care settings (n= 1). Most reviews showed mixed evidence to
support interventions’ effectiveness, due to the significant
heterogeneity between original research studies in respect to sites,
samples sizes and intervention periods. However, in all intervention
categories, pharmacists’ collaboration with other health care
professionals was most beneficial, showing definitive evidence for
improving medication safety and quality of prescribing in RACS. The
evidence suggests that combining two or more interventions is the most
promising approach, despite this presenting implementation barriers in
the resource-limited environments of many RACS, and methodological
challenges in identifying the precise contribution of individual
interventions, when implemented concurrently. Conclusion: Health
stakeholders should explore a combination of at least two interventions,
such as medication review and staff education, to improve medication
safety in RACS.