Medication Safety Needs Rounds in long-term care facilities: a feasibility study

The Medication Safety Needs Rounds model is an interprofessional approach to improving medication safety in long-term care facilities (LTCFs). Medication Safety Needs Rounds involves a monthly cycle of identifying residents at risk of medication-related harm and conducting a triage meeting to discuss residents’ medication management needs, trigger subsequent actions and develop a plan, and then documenting meeting discussions and implementing follow-up actions. The interprofessional team meetings are designed as a triage meeting to facilitate a brief discussion of residents’ medication management needs among the team and interprofessional collaboration to proactively identify strategies to resolve medication-related issues. We will conduct a non-randomised mixed-methods feasibility study, guided by the Consolidated Framework for Implementation Research and key principles of feasibility studies, to answer the overarching question: ‘Can it work?’. This study will implement the Medication Safety Needs Rounds intervention across six LTCFs, with each LTCF conducting monthly meetings (approximately 1 hour in duration) for six months (i.e., 36 needs rounds overall). Each LTCF will be provided with a package of written implementation resources and tools that have been refined during a previous co-design study (1). The research team will provide hard and digital copies of the implementation package to each LTCF team (including the aged care on-site pharmacist, managers, nurses and general medical practitioners where appropriate) at the start of the implementation period. Aged care on-site pharmacists (ACOPs), and other health professionals, will be guided by the triggers identified in the Pocket Guide (provided in the co-designed implementation tools and resources package) to identify and prioritise approximately six to eight residents to discuss at each meeting. The Pocket Guide was informed by existing resources for prioritising individuals for clinical pharmacy services and monitoring medication management in LTCFs and refined during the co-design process. The triggers for identifying residents for discussion in the meeting are focused on changes in resident’s health and wellbeing, medication management issues, recent care transitions, and concerns from the resident, their family or supporters, and other health professionals. Health professionals using the Pocket Guide are expected to use their professional judgement and clinical expertise to screen, identify and select residents for the Medication Safety Needs Rounds meeting. The research team will work with members of each participating LTCF care team (e.g., managers, nurses, ACOPs, general medical practitioners (GPs)) to provide training and support prior to intervention commencement, and will embed regular opportunities for support and knowledge sharing throughout the study period (e.g., online drop-in sessions, phone and email communications). Training will focus on implementation and data collection processes, individuals’ roles, interprofessional communication/collaboration, communication with residents and their family or supporters, and use of the co-designed written implementation tools and resources. An online workshop (~2 hours) will be available for individuals involved or participating in Medication Safety Needs Rounds at each of the participating sites. An additional online workshop (~1.5 hours) will be available for ACOPs at each participating site. The training will be provided prior to the first Medication Safety Needs Rounds meeting at each site, and will be recorded and made available (together with accompanying slide decks) after the session. Pre-implementation engagement with participating LTCFs (e.g., online meetings and communication over email/telephone) will also develop an implementation plan with each site, including planning for study processes, data collection/reporting, site-specific flexibility, and strategies to engage GPs in needs rounds. The ACOPs will lead the Medication Safety Needs Rounds process and provide oversight of meeting preparation, documentation and completion of follow-up activities. In Australia, ACOPs are clinical pharmacists credentialled to work on-site in LTCFs. The ACOP role is grounded in provision of person-centred care (e.g., readily available, effective communication and collaboration with residents and supporters) and encompasses activities such as medication management (e.g., medication reconciliation, reviews), clinical governance (e.g., contributions to Medication Advisory Committees or other clinical governance structures), quality use of medicines (e.g., medication information, facility-wide quality improvement, education) and interprofessional communication and collaboration (e.g., multidisciplinary case conferences, care planning). Pre-meeting documentation (e.g., meeting agenda) will be circulated to needs rounds members prior to each meeting. ACOPs will be encouraged to ensure that each resident’s needs and preferences for medication management will be sought prior to the meeting via discussion with the resident and/or their supporter, and to follow-up with them after the meeting to facilitate shared decision-making. Members of the interprofessional Medication Safety Needs Rounds meeting may include the ACOPs, managers, GPs, nurses and personal care workers who administer medications, although the specific structure and representation of various roles and professions may vary between LTCFs (e.g., GP involvement). In each meeting, specific team members will be responsible for chairing the meeting and recording minutes, with guidance provided in the implementation materials. Documentation of action items and follow-up plans will be recorded using the co-designed templates. Follow-up actions triggered by the Medication Safety Needs Rounds meeting may include, for example, subsequent clinical work or support (e.g., case conference, comprehensive medication review, referral to allied health, specialist care or a support program, advanced care plan, lifestyle and wellbeing support, family meeting), changes to medication regimens (e.g., deprescribing, prescribing, supporting self-administration), staff education, or clinical governance activities (e.g., drug use evaluation, audit and feedback). Action plans will be documented after each meeting and followed up at the beginning of the next meeting to support the cyclical nature of the model. The needs rounds model supports the proactive identification and implementation of follow-up actions, interprofessional communication/collaboration, documentation, shared medication knowledge, and communication with residents and their families or supporters about medications. The model incorporates some flexibility to account for differences in practice between LTCFs and providers and this is reflected in the provision of guidance for some processes rather than specific requirements. Core components of the intervention include oversight and leadership by the ACOP, monthly interprofessional meetings focused on medication safety, and the development and documentation of action plans. Elements of flexibility can include the structure of GP involvement/attendance, documentation and reporting processes, intersection with other team meetings (including palliative care needs rounds), telehealth, and meeting attendees. Acknowledging some flexibility in the delivery between LTCFs ensures that it meets site-specific needs and this will be comprehensively evaluated to inform scale-up. This non-randomised feasibility study involves all participating LTCFs implementing the intervention, thus none are disadvantaged. De-identified documentation and tracking of Medication Safety Needs Rounds activities and resource utilisation data will be collected from each LTCF to assist assessment of adherence and fidelity, together with regular discussions and support between the sites and the research team during implementation. The description of this intervention adheres to the Better Reporting of Interventions: Template for Intervention Description and Replication (TIDieR) checklist. 1. Hughes, GA, Javanparast, S, Davis, A, Gwilt, I, Yin, H, Little, K, Gutteridge, DS, Sluggett, JK, on behalf of the Medication Safety Needs Rounds Investigator Team. Resource pack to support implementation of Medication Safety Needs Rounds in long-term care facilities. Adelaide: Adelaide University; 2026. doi: https://doi.org/10.25909/32441520