National audit reveals gaps and opportunities in aged care medication governance

A detailed national audit has uncovered wide variability in the structure and function of Medication Advisory Committees (MACs) across Australia’s residential aged care sector, highlighting urgent opportunities to strengthen medication governance and improve clinical oversight.

Published in the Australasian Journal on Ageing, the audit represents the first national-level assessment of MACs and their alignment with government-endorsed standards.

Researchers from the Centre for Medicine Use and Safety (CMUS), within the Monash Institute of Pharmaceutical Sciences (MIPS), led the national audit to examine how MACs function across their four recommended operational domains: policy development, risk management, education, and quality improvement.

The findings, derived from responses representing 120 MACs across 642 facilities (24% of Australian residential aged care homes), paint a mixed picture of compliance and capability.

“This audit highlights both the strengths and the areas needing targeted support in how we manage and govern medication safety in aged care. MACs have the potential to lead transformational change in this sector – if adequately supported and resourced,” said thee study’s lead author, CMUS research fellow Dr Amanda Cross.

MACs play a critical role, but many are falling short

MACs are multidisciplinary committees recommended for all residential aged care services to ensure safe, appropriate, and high-quality use of medications. Despite their centrality to medication safety, the audit found that only:

• 58% of MACs were truly multidisciplinary, including nursing, pharmacy, and prescriber input
• 59% fully met policy development roles
• 53% met risk management benchmarks
• 41% delivered all education-related functions
• Only 28% performed all quality improvement functions outlined in the national Audit Tool

These results signal a significant gap between intent and implementation, especially in key domains like workforce education and continuous quality improvement.

System governance needs strengthening

As identified by the Royal Commission into Aged Care Quality and Safety, ‘better system governance is crucial to the reform of aged care’.

Positively, two-thirds of MACs reported having up-to-date terms of reference and three-quarters were chaired by an internal staff member.

The report also found that most MACs were chaired internally, often by a registered nurse, with only 17% led by a pharmacist. Authors suggest a stronger case can be made for appointing independent chairs to enhance clinical governance and transparency.

While 93% of MACs included an accredited or credentialed pharmacist, just 58% had general practitioner involvement, despite medical prescribers being one of the three core disciplines.

This low representation underscores the ongoing challenge of engaging GPs in aged care governance, even amid the rollout of the Australian Government’s 2024 GP in Aged Care incentives.

The data also suggests there may be scope to optimise MAC operation by improving clarity regarding the role of the MAC in areas such as policy development, risk management, education and quality improvement.

Encouragingly, nearly all MACs reported being responsive to medication-related risks. However, fewer than half developed action plans in response, and only a minority measured resident experiences with medication, a key aspect of consumer-centred care.

Homes in non-metropolitan areas were significantly less likely to meet quality improvement functions compared to their metropolitan counterparts. This disparity raises concerns about equity in medication safety and calls for targeted support in regional, rural, and remote settings.

Where to from here?

The audit provides much-needed national benchmarking data and a powerful springboard for quality improvement. Aged care providers are encouraged to:

• Review their MAC’s terms of reference and multidisciplinary composition
• Benchmark performance using the national Audit Tool
• Invest in upskilling MAC members and facility staff on medication governance
• Consider independent or pharmacist-led MAC chairs
• Engage GPs and external clinical experts through flexible meeting formats

Dr Cross and colleagues call for further research into the impact of MAC performance on resident outcomes and the cost-effectiveness of improvement interventions.

As medication safety remains a key pillar of aged care reform, optimising the function of MACs is not just an operational necessity, but a clinical imperative.