A practical framework to support safer prescribing and medication monitoring
Victorian researchers have developed the first national consensus-based list of high-risk medicines specifically tailored to residential aged care, creating a practical tool designed to help clinicians identify medications that require enhanced monitoring and risk management. The new framework, known as OZ-ABCD, aims to support safer prescribing, administration and monitoring practices for older Australians living in aged care facilities.
The tool was developed by researchers from Monash University, working alongside a multidisciplinary group of healthcare professionals and medication safety experts. Published in the Australasian Journal on Ageing, the study identified 15 high-risk medicines or medication classes associated with a significant risk of serious harm or death if used incorrectly or if monitoring systems are inadequate.
Medication-related harm remains a significant challenge in residential aged care. Residents frequently have multiple chronic conditions, are prescribed numerous medicines and often experience age-related physiological changes that can increase susceptibility to adverse drug events. While healthcare organisations are required to implement systems that identify and manage high-risk medicines, researchers noted that existing high-risk medication lists are not specifically designed for the complexities of residential aged care.
According to the research team, this gap highlighted the need for a nationally relevant resource tailored to the Australian aged care sector. The resulting OZ-ABCD framework was designed to provide an evidence-informed and easy-to-use tool that can be incorporated into routine clinical practice.
Lead author Dr Amanda Cross, Senior Research Fellow at the Centre for Medicine Use and Safety within the Monash Institute of Pharmaceutical Sciences, said the tool addresses an important deficiency in current medication safety resources.
"We need a high-risk medication list that is tailored to the needs of Australian residential aged care," Dr Cross said.
"The OZ-ABCD tool gives busy clinicians and aged care staff a simple, memorable way to identify high-risk medications and ensure systems and monitoring are in place to keep residents safe," Dr Cross said.
The mnemonic was designed to make recall and implementation straightforward for clinicians working in busy residential aged care environments. OZ-ABCD represents six categories of medicines associated with elevated risk:
- O: Opioids
- Z: Z-drugs and benzodiazepines
- A: Antipsychotics and lithium
- B: Blood thinners
- C: Chemotherapeutic agents and methotrexate
- D: Diabetes agents with a high risk of hypoglycaemia
These medication groups were identified through a rigorous national consensus process involving experts from a range of clinical disciplines and medication safety backgrounds. The researchers sought to develop a practical framework that could help aged care providers focus their safety efforts on medicines most commonly associated with severe adverse outcomes.
The authors suggest the tool could support a range of quality and safety initiatives within residential aged care, including staff education, medication review processes, risk management programs and the implementation of monitoring protocols for residents receiving high-risk medicines. By improving awareness of these medication classes, facilities may be better positioned to prevent medication-related injuries and adverse events.
Importantly, the OZ-ABCD tool was developed specifically for the Australian aged care context rather than being adapted from hospital-based frameworks. Researchers say this tailored approach recognises the unique clinical characteristics of aged care residents and the specific medication safety challenges encountered in these settings.
The research team believes the framework can serve as an accessible resource for clinicians, pharmacists, nurses and aged care staff, supporting more consistent identification of residents at increased risk of medication-related harm. Ultimately, the goal is to help reduce preventable adverse events among a particularly vulnerable population.
For clinicians working across aged care, general practice, pharmacy and geriatric services, the OZ-ABCD framework provides a concise, nationally developed reference point for recognising high-risk medicines and ensuring appropriate safety systems and monitoring are in place. As medication-related harm continues to be a major patient safety concern, the tool offers a practical approach to strengthening medication stewardship in residential aged care.