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Title:	The development of best practice model for medication management in residential aged care facilities
Authors:	Mariani Ahmad Nizaruddin (P86093)
Supervisor:	Marhanis Salihah Omar, Dr.
Keywords:	Health Services Accessibility Medication Access Universiti Kebangsaan Malaysia -- Dissertations Dissertations, Academic -- Malaysia
Issue Date:	1-Oct-2022
Description:	The Malaysian population is aging and the safe and quality care of the elderly in the community setting is of much concern. It is projected that more residential aged care facilities (RACF) will be developed to cater for them. This study aimed to identify issues concerning medication management in the RACF settings in Malaysia and to develop a novel best practice model for medication management. The study consisted of four phases. In Phase 1, interviews with several stakeholders of RACF were conducted to understand the RACF landscape in Malaysia and the issues surrounding medication management. The themes that emerged were medication use, personnel handling medication and culture of the organisation. In Phase 2A, the knowledge, attitude and practice (KAP) of 128 caregivers on medication management of RACF were determined. Most of the caregivers (71.9%) deemed to know what medication management entails. However, nearly half of them (48.4%) have never undergone any training on it. More than half of the caregivers possessed a good level of knowledge (69.5%, n = 89) and had a good attitude (57.8%, n= 74). However, less than half of the caregivers in RACF had good practice (46.9%, n= 60) on medication management. The level of education, special qualification, having medication management training were factors that correlated with good score outcomes (p<0.05). Special qualification possessed by caregivers was a predictor for knowledge on medication management. The Phase 2B investigated the level of knowledge and practice of 124 residents on medication medication management and their belief about medication. Residents were categorised as having poor scores in knowledge (mean <60%) in 46.8%, n=59) and poor practice (n=107,84.9%) of medication management. Higher level of education correlated with belief in the necessity of medicines (p<0.05). The Necessity-Concerns differential score was measured, and around half of the residents believed in medication (n= 64, 50.8%). In Phase 3, time-motion observation analyses and interviews were conducted with nurses, caregivers, prescribers, and administrators of three RACFs settings. A classification system of medication management activities detailing error prone processes was drawn up. Processes of medication administration and transition of residents as well as documentation deficiencies proved to be problematic areas. In Phase 4 of the study, Six-sigma DMAIC (Define, Measure, Analyse, Improve, Control) summarised a problem-solving approach for process improvement and reduction of medication use issues.A best practice model on medication management was proposed to the participants and their feedback was obtained by survey and interviews. RACFs should provide their personnel with medication management training. Information sharing among healthcare providers should be upheld to provide continuity of care. Residents' autonomy and empowerment was also incorporated in the model. A culture of continuously improving medication management activities without punitive actions should be adopted. The main recommendation from this study is for the authorities to regulate standards of medication management and govern policies to implement best practice of medication management system at respective RACFs,Ijazah Doktor Falsafah
Pages:	220
Publisher:	UKM, Kuala Lumpur
Appears in Collections:	Faculty of Pharmacy / Fakulti Farmasi

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