What applies

Outcome 5.3: Safe and quality use of medicines. Providers are to support the use of medicines in ways that maximise benefit and minimise harm, make sure medicines are prescribed, administered, monitored and reviewed with the person’s informed decisions in mind, and monitor and report medicine-related adverse events ⁸.
Action 5.3.1. A medication management system with governance, such as a Medication Advisory Committee in residential services, policies, documentation and an adverse event reporting system ⁸.
Action 5.3.2. Medication review at least annually and after transitions of care, acute illness or adverse events, considering whether each medicine is still needed and the risks of stopping it ⁸.
Action 5.3.3. Allergies and adverse reactions documented, kept up to date and available to prescribers, dispensers and staff who administer medicines ⁸.
Action 5.3.4. Processes for high-risk medicines, including opioids, anticoagulants, insulin and psychotropics, with monitoring, review, planned pharmacist review and deprescribing where appropriate ⁸.
Action 5.3.5. Reporting of adverse medicine events to the Therapeutic Goods Administration, with staff trained to do so ⁸.
Action 5.3.6. Monitoring and evaluation of medicine safety, including adverse event trends and how often reviews happen, reported to the governing body, staff and older people ⁸.
Restrictive practices. A medicine used as chemical restraint must meet the requirements for any restrictive practice, including last resort, least restrictive form, a behaviour support plan and informed consent ²⁰.

The two medication indicators

Under the National Aged Care Mandatory Quality Indicator Program, homes report two medication indicators each quarter ⁵.

Polypharmacy is the proportion of residents prescribed nine or more medicines on a collection date the home chooses. Topical skin and wound products, dietary supplements including vitamins, short-term medicines such as antibiotics, and as-needed medicines are not counted, and different doses of the same medicine count once ⁶.

Antipsychotic use is the proportion of residents who received an antipsychotic during a seven-day review of medication charts or administration records. Residents with a medically diagnosed psychosis are counted separately but remain in the total ⁷.

Nationally, both indicators fell significantly over the 20 quarters from July to September 2021 to April to June 2026. Chemical restraint is not part of the separate restrictive practices indicator ⁵.

Reading the numbers

A polypharmacy figure measures the length of medication lists, not their quality. A home could lower it by stopping useful medicines, or keep it high for good reasons. Because as-needed medicines are not counted, moving a medicine from regular to as-needed lowers the figure without changing what the resident may receive ⁶.

The antipsychotic figure includes appropriate treatment of psychosis, which is why the psychosis count is reported separately ⁷. Internally, the number of residents on an antipsychotic without a diagnosed psychosis, and how long each has been on it, tells a home more.

Potentially inappropriate antipsychotic and benzodiazepine use varies widely between Australian homes, and the difference persists after adjusting for resident and home characteristics ¹⁹.

Where the evidence suggests effort counts

Regular, structured review with the usual prescriber involved. Review improves medication lists in trials ^9,10. The features linked with success in falls trials were a decision tool, a prescriber from the usual care team and review at least every six months ¹⁴.
Pharmacist time on site. An Australian cluster randomised trial found fewer potentially inappropriate medicines and lower antipsychotic doses with an on-site pharmacist ⁴⁴.
Audit, feedback and case review for psychotropics. Programs of this kind in Australian homes reduced antipsychotic and benzodiazepine use without substitution, although they were not randomised ^17,18.
Non-drug approaches to behaviour. The national Clinical Care Standard puts non-drug strategies first and alongside any psychotropic medicine ²¹.
Learning from incidents. In 25 New South Wales homes, more than half of medication incidents arose at administration, and respite residents had about twice the incident rate of permanent residents ⁴.

Working with visiting clinicians

A medication review depends on current information: an accurate chart, recent observations, bowel and sleep charts, falls and behaviour records, and what the resident and family have said. Having these ready at the GP’s visit is the part of the process the home controls.

Clear records of who the resident’s decision-maker is, and of their goals of care, make decisions about preventive and psychotropic medicines quicker and more likely to match what the resident wants.

Sources cited on this page

4 Silva SSM, Wabe N, Raban MZ, et al. Characteristics and risk factors of medication incidents across stages of medication management in residential aged care: a longitudinal cohort study of 5700 reported incidents. Drug Saf. 2026;49(2):195–206. (25 New South Wales homes, 2014–2021; observational.) View source
5 Australian Institute of Health and Welfare, GEN Aged Care Data. Residential Aged Care Quality Indicators — April to June 2026. Released October 2026. (2,564 residential care homes; trend analysis July–September 2021 to April–June 2026.) View source
6 Australian Government Department of Health, Disability and Ageing. National Aged Care Mandatory Quality Indicator Program: quick reference guide — medication management, polypharmacy. 2025. View source
7 Australian Government Department of Health, Disability and Ageing. National Aged Care Mandatory Quality Indicator Program: quick reference guide — medication management, antipsychotics. 2025. View source
8 Aged Care Quality and Safety Commission. Strengthened Aged Care Quality Standards: Outcome 5.3 Safe and quality use of medicines, Actions 5.3.1 to 5.3.6, with guidance. View source
9 Alldred DP, Kennedy MC, Hughes C, Chen TF, Miller P. Interventions to optimise prescribing for older people in care homes. Cochrane Database Syst Rev. 2016;(2):CD009095. (12 randomised trials, 10,953 residents.) View source
10 Carollo M, Cristini I, Crisafulli S, et al. Evaluating the impact of medication review and deprescribing on prescribing appropriateness and clinical outcomes in older people residing in long-term care facilities: a systematic review and meta-analysis. Age Ageing. 2026;55(4):afag084. (38 studies, 22 randomised; search to August 2024.) View source
14 Suen J, Narayan S, Seppala LJ, et al. Features of successful medication review and deprescribing interventions for fall prevention in residential aged care facilities: an intervention component analysis of an updated systematic review. Age Ageing. 2025;54(8):afaf230. (13 trials; hypothesis-generating.) View source
17 Brodaty H, Aerts L, Harrison F, et al. Antipsychotic deprescription for older adults in long-term care: the HALT study. J Am Med Dir Assoc. 2018;19(7):592–600.e7. (Single-arm study, 23 Sydney nursing homes; not randomised.) View source
18 Westbury JL, Gee P, Ling T, et al. RedUSe: reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities. Med J Aust. 2018;208(9):398–403. (Prospective non-randomised intervention, 150 homes.) View source
19 Sawan MJ, Clough AJ, Hillen J, et al. Variation in the potentially inappropriate use of antipsychotic and benzodiazepine medications among individuals receiving residential medication management reviews. Int J Pharm Pract. 2025;33(3):332–9. (15,442 residents in 342 Australian homes, 2019; cross-sectional.) View source
20 End of Life Law for Clinicians, Australian Centre for Health Law Research, Queensland University of Technology. Restrictive Practices in Aged Care (factsheet on the Aged Care Act 2024 and Aged Care Rules 2025). November 2025. View source
21 Australian Commission on Safety and Quality in Health Care. Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard. Sydney: ACSQHC. View source
44 Haider I, Kosari S, Naunton M, et al. Impact of on-site pharmacists in residential aged care facilities on the quality of medicines use: a cluster randomised controlled trial (PiRACF study). Sci Rep. 2023;13:15962. (15 Australian homes; not blinded.) View source

See every source cited across the medicines and deprescribing section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at October 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. Evidence and Australian regulatory, PBS and program arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

Medicines: a guide for facility leadership