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Journal article
Development of a High-Risk Medication List for Australian Residential Aged Care: A Modified Delphi Study
Australasian journal on ageing, Vol.45(1), e70141
2026
PMID: 41748493
Abstract
Introduction
High-risk medications are medications associated with significant patient harm or death if misused or used in error. This study aimed to develop a national consensus high-risk medication list for use in Australian residential aged care.
Methods
A 3-round modified Delphi study involving Australian healthcare professionals was conducted. In Round 1, participants indicated their level of agreement, on a 9-point Likert scale, whether 60 medications/medication classes were considered high-risk and should be included in a high-risk medication list for Australian residential aged care. Round 2 included medications/medication classes that did not reach consensus and new medications identified by participants. Consensus was defined as 70% or more of participants responding at 7 or higher on the Likert scale. In Round 3, participants were asked to prioritise medications/medication classes that reached consensus in Round 1 or 2.
Results
In total, 42 participants completed Round 1, and 35 (83%) completed all three rounds. Participants included pharmacists (n = 21), prescribers (n = 15), nurses (n = 5) and a paramedic (n = 1), with representation from all Australian states and mainland territories. Overall, 26 medications reached consensus (21 in Round 1, five in Round 2) and were categorised into 15 medications/medication classes for prioritisation in Round 3. The final prioritisation list was opioids, insulin, benzodiazepines, anticoagulants, z-drugs, antipsychotics, lithium, sulfonylureas with high risk of hypoglycaemia, chemotherapeutic agents, methotrexate, digoxin, narrow therapeutic range antiepileptics, tricyclic antidepressants, immunosuppressants for transplant and sedating antihistamines.
Discussion
This is the first, national consensus list of high-risk medications developed specifically for Australian residential aged care. It can be used to implement targeted strategies to minimise medication-related harm.
Details
- Title
- Development of a High-Risk Medication List for Australian Residential Aged Care: A Modified Delphi Study
- Authors/Creators
- Amanda J. Cross - Monash UniversityMadiha Chaudhry - Monash UniversityDarshna Goordeen - Monash UniversityJuanita L. Breen - Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, AustraliaMalcolm Clark - Department of General Practice and Primary Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, AustraliaStephanie Daly - Royal Australian College of General PractitionersBelinda Delardes - Monash UniversityBente Hart - Southern New South Wales Local Health District, NSW Health, Braidwood, NSW, AustraliaDeborah Hawthorne - Centre for Optimisation of Medicines, School of Health and Clinical Sciences, University of Western Australia, Perth, WA, AustraliaPeter J. Hayball - South Australian Ambulance Service, Clinical Services Directorate, Eastwood, SA, AustraliaSarah N. Hilmer - Faculty of Medicine and Health, Kolling Institute, The University of Sydney and Northern Sydney Local Health District, St Leonards, NSW, AustraliaLisa Kouladjian O’Donnell - School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, AustraliaMary Ann Kulh - University of CanberraKenneth Lee - Centre for Optimisation of Medicines, School of Health and Clinical Sciences, University of Western Australia, Perth, WA, AustraliaDavid F.L. Liew - Department of Medicine, University of Melbourne, Parkville, VIC, AustraliaStephen Macfarlane - Dementia Support Australia, Melbourne, VIC, AustraliaElizabeth Manias - Monash UniversityAnthony Marinucci - Royal Australian College of General PractitionersConstance Dimity Pond - Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, AustraliaHelen Rawson - Monash UniversitySusan Slatyer - Murdoch University, Centre for Healthy AgeingAndrew Stafford - Curtin UniversityAmy B. Thomson - New South Wales Poisons Information Centre, Westmead, NSW, AustraliaKate Wang - RMIT UniversityKirolos Wasef - ACT GovernmentJonathan Zimmerman - Health of Older Persons, Bayside Health (Alfred Care Group), Melbourne, VIC, AustraliaNadine E. Andrew - Monash UniversityGauri P. Godbole - Central Coast Local Health DistrictLouise Lord - The Royal Melbourne HospitalAtish Manek - Monash UniversityBrigid McInerney - Monash HealthMichelle Steeper - Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, AustraliaJustin P. Turner - Monash UniversityJ. Simon Bell - Monash University
- Publication Details
- Australasian journal on ageing, Vol.45(1), e70141
- Publisher
- John Wiley & Sons Australia, Ltd on behalf of AJA Inc.
- Number of pages
- 15
- Grant note
- Flinders University (http://data.elsevier.com/vocabulary/SciValFunders/501100001785) Curtin University of Technology (http://data.elsevier.com/vocabulary/SciValFunders/501100001797) APP2009633 / National Health and Medical Research Council (http://data.elsevier.com/vocabulary/SciValFunders/501100000925) National Health and Medical Research Council (http://data.elsevier.com/vocabulary/SciValFunders/501100000925) Wiley - Monash University University of Melbourne (http://data.elsevier.com/vocabulary/SciValFunders/501100001782) Department of Health, Government of Western Australia (http://data.elsevier.com/vocabulary/SciValFunders/501100006065) Australasian University Librarians Western Australian Future Health and Innovation Fund, Government of Western Australia (http://data.elsevier.com/vocabulary/SciValFunders/501100024253) Neil Petrie
- Identifiers
- 991005869305107891
- Copyright
- © 2026 The Author(s).
- Murdoch Affiliation
- Centre for Healthy Ageing; School of Nursing
- Language
- English
- Resource Type
- Journal article
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