Maximising Embedded Pharmacists in AGed CAre Medication Advisory Committees (MEGA-MAC): Protocol for implementing Australia’s new guiding principles for medication management in residential aged care facilities using knowledge brokers and a national quality improvement collaborative.

Abstract

Background: Incomplete or delayed implementation of Guidelines can lead to potentially avoidable medication-related harm. All Australian residential aged care facilities (RACFs) are recommended to have access to a multidisciplinary medication advisory committee (MAC) to provide clinical governance of medication management. The objective of this trial is to evaluate the effectiveness and relative net benefit of using knowledge brokers, supported by a national quality improvement collaborative, to implement Australia’s new Guiding Principles for Medication Management in Residential Aged Care Facilities (Guiding Principles). Methods: The Maximising Embedded Pharmacists in AGed CAre Medication Advisory Committees (MEGA-MAC) trial will be conducted in partnership with RACFs operated by three aged care provider organizations across four states of Australia. The intervention will involve knowledge broker dyads (pharmacist plus a MAC representative [e.g. nurse]) developing, implementing and evaluating RACF-specific local action plans to implement the Guiding Principles in up to 15 RACFs. Knowledge broker dyads will be supported by a national quality improvement collaborative (MEGA-MAC collaborative) comprising clinical experts, implementation scientists and resident and caregiver representatives. An interrupted time series design will be used to assess change over time with three pre-intervention (-6, -3 and 0 months) and three post-intervention assessment time points (+ 3, + 6, + 9 months). The primary outcome will be change in pre/post RACF-level concordance with the Guiding Principles measured using quality indicators (score 0 to 28, higher scores = greater concordance). A net benefit analysis will be conducted to examine the relative costs and benefits of implementing the intervention. Discussion: The MEGA-MAC trial investigates a novel multifactorial knowledge translation strategy to improve the uptake of guidelines and support safe and appropriate use of medication in RACFs. We anticipate that the findings will provide new information on the role of healthcare professionals as knowledge brokers, MACs, and quality improvement collaboratives for effective guideline implementation in RACFs. Ethics and dissemination: Ethics approval obtained from Monash University and Grampians Health Human Research Ethics Committees. Findings will be disseminated through professional and lay media, conference presentations and peer-reviewed publications. Trial registration: Australian New Zealand Clinical Trial Registry (ANZCTR): ACTRN12624000894594. Registered 22nd July 2024 – Prospectively registered. https://www.anzctr.org.au/ACTRN12624000894594.aspx