Is it too much to expect 4 hourly pain medication to be administered?

28_3_23 pain medication administration HC

A palliative care patient attempting to access respite care decided to care for herself at home after she was told there wouldn’t be enough Registered Nurses (RNs) on duty to dispense her pain medication on a four-hourly basis.

This has raised concerned around how common this situation is among Australian aged care facilities.

An article published by ABC today tells the story of 66-year-old Leah* who needs pain medication administered every four hours to cope with extreme pain from the scar tissue formed on her bowel and intestines from a number of surgeries. 

The medication gives Leah a few hours relief with enough mobility to walk her beloved dog, Pepper. 

“My dear dog has been abandoned once, I am doing my best to see him out. He is ten now and I’m seriously doubting I can do that,” Leah told ABC.

“Everything is worked around pain medication.”

Last year, when Leah had septicaemia and was discharged from hospital, she sought respite care at an aged care facility. But with staff shortages causing delays in medication administration, Leah has no choice but to look after herself at home.

“I was pretty upset because it was considered urgent by the people who assessed me,” said Leah.

“The main reason I wanted to speak [up] is there are a lot of people in nursing homes who aren’t getting their pain relief and that really upsets me because I know what it means.”

Australia is expected to be 200,000 workers short in the care sector by 2050 and last week, the Federal Government admitted its target to staff aged care homes with one registered nurse 24/7 will not be met by the July deadline. 

A former aged care RN, Nurse X, said that many homes might agree to administer medication four times per day, but in reality, there aren’t enough resources for nurses to properly review and administer medications in a timely manner. 

She said that previously, General Practitioners (GPs) used to prescribe Panadol to residents four times per day but quickly worked out it was getting missed and typically now only prescribe it three times per day. 

“To do it properly, there isn’t enough time and as a result, I can only assume shortcuts are made as there is no physical way to administer medication to that many residents in the time allocated on top of other tasks for the day,” Nurse X explained.

On one shift, Nurse X was the only RN on shift responsible for 130 residents – three of which were palliative care residents who were dying. Ordinarily, in a palliative care facility, there would be a 1:4 staff-to-resident ratio.

“It’s a systemic issue, not an isolated case.”

Perron Institute Research Chair in Palliative Care at the University of Western Australia, Professor Samar Aoun, told Cosmo Magazine that palliative care is partially a community responsibility and the formal services need to work with informal networks.

“To get much better healthcare, much better quality of life, and much better quality of death, we need to have the community involved – they need to know that this is their responsibility,” she explained.

“The number of us dying in the next 25 years is going to double, so who’s going to look after us? You can’t have palliative care services in every Australian suburb and that’s not the answer anyway, even if we had the money.”


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  1. I would like to comment two issues registered nurses. This term is most misleading.
    Nurse education has been a business for years. Nurse education and registration is very confusing.
    i.e registrated Nurse Division 1 is actually refered to as a RN
    a registered Nurse Division 2 is actually a enrolled Nurse EN

    Since Nursing registration is devoid of any requirement to have any actual clinical experience. to hold any charge positions in Nursing homes. i.e they are P plate drivers. There Nursing registration needs to be more relevant in its registration cateorgies. Age Care will not improve unless “expericenced clinical nurses are in charge” a few General Nurse Managers of nursing homes have little to no clinical experperience and therefore not able to attract decently qualified nurses , they able to assist the EN and mentor and assist carers. Carers are left to deliver the care quite simply nurses basically sit at the desk and do not have any desire to care for anyone care-recipients or the overworked and underpaid and stressed carers.a

  2. As usual the negative voices are heard above all else in aged care – no wonder aged care finds it so hard to attract Nursing and other staff. I love how this article implies through the voice of a single Registered Nurse that it is impossible to administer medications on time – which is one of the 6 rights of medication administration in health care. This is simply not the case, there are many different models of care across the country – as aged care is not a ‘one size fits all’ – it is widely accepted practice that an RN is able to delegate clinical care to appropriately trained and competant staff. This is an absolute necessity in aged care and with robust and effective procedures in place many aged care facilities can and do provide effective and appropiate palliative care to their residents and community. I implore the editor/publisher of this site to provide a balanced voice for aged care and not just give a voice to the negative and sensational.


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