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Kummer I, Reissigová J, Lukačišinová A, Ortner Hadžiabdić M, Stuhec M, Liperoti R, Finne-Soveri H, Onder G, van Hout H, Fialová D. Polypharmacy and potentially inappropriate prescribing of benzodiazepines in older nursing home residents. Ann Med 2024; 56:2357232. [PMID: 38833339 DOI: 10.1080/07853890.2024.2357232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia. METHODS Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented. RESULTS The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2-3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8). CONCLUSIONS Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations.
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Affiliation(s)
- Ingrid Kummer
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic
| | - Jindra Reissigová
- Department of Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Prague, The Czech Republic
| | - Anna Lukačišinová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic
| | - Maja Ortner Hadžiabdić
- Center for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Matej Stuhec
- Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia
- Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ormoz, Slovenia
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hein van Hout
- Departments of General Practice and Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, The Czech Republic
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Tocco Tussardi I, Tardivo S, Mazzi MA, Rimondini M, Visentin D, Busch IM, Torri E, Moretti F. Unpacking Perceptions on Patient Safety: A Study of Nursing Home Staff in Italy. Healthcare (Basel) 2024; 12:1440. [PMID: 39057583 PMCID: PMC11276544 DOI: 10.3390/healthcare12141440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Nursing homes (NHs) are crucial for de-hospitalization and addressing the needs of non-self-sufficient individuals with complex health issues. This study investigates the patient safety culture (PSC) in NHs within a northern Italian region, focusing on factor influencing overall safety perceptions and their contributions to subjective judgements of safety. A cross-sectional study was conducted on 25 NHs in the Autonomous Province of Trento. The Nursing Home Survey on Patient Safety Culture (NHSPSC) was utilized to assess PSC among NH staff. Multilevel linear regression and post hoc dominance analyses were conducted to investigate variabilities in PSC among staff and NHs and to assess the extent to which PSC dimensions explain overall perceptions of PS. Analysis of 1080 questionnaires (44% response rate) revealed heterogeneity in PSC across dimensions and NHs, with management support, organizational learning, and supervisor expectations significantly influencing overall safety perceptions. Despite some areas of concern, overall safety perceptions were satisfactory. However, the correlation between individual dimensions and overall ratings of safety was moderate, suggesting the need to enhance the maturity level of PSCs. Promoting a shift in PSC could enhance transparency, prioritize resident safety, empower nursing staff, and increase family satisfaction with care provided in NHs. The support provided by management to PSC appears essential to influence NH staff perceptions of PS.
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Affiliation(s)
- Ilaria Tocco Tussardi
- Department of Diagnostics and Public Health, Section of Hygiene, University of Verona, 37134 Verona, Italy
| | - Stefano Tardivo
- Department of Diagnostics and Public Health, Section of Hygiene, University of Verona, 37134 Verona, Italy
| | - Maria Angela Mazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Michela Rimondini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Donatella Visentin
- Department of Prevention, Healthcare Trust of the Autonomous Province of Trento, 38123 Trento, Italy
| | - Isolde Martina Busch
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Emanuele Torri
- Clinical Governance Service, Healthcare Trust of the Autonomous Province of Trento, 38123 Trento, Italy
| | - Francesca Moretti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
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Tocco Tussardi I, Cazzoletti L, Zanolin ME, Comini A, Visentin D, Torri E, Tardivo S, Moretti F. Patient Safety Subcultures among Nursing Home Staff in Italy: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:1962. [PMID: 37444796 DOI: 10.3390/healthcare11131962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Nursing home (NH) residents are vulnerable subjects and highly susceptible to adverse events. Knowledge of patient safety culture (PSC) is essential for an organization to ensure patient safety. However, research on PSC in NHs, and its variability among staff, is still scarce. This study aimed to explore whether and how PSC differed among NH staff (Managers, Nurses, Direct Care Staff, Support Staff, Administrative Staff and Other Providers) in the Autonomous Province of Trento, Italy. This study employed a cross-sectional design and collected data from 1145 NH providers using the Nursing Home Survey on Patient Safety Culture (NHSPSC). Data were analyzed using linear mixed models, with each of the 12 NHSPSC domains as a response variable. The majority of the respondents (61.6%) were Direct Care Staff members. 'Feedback and Communication about Incidents' and 'Overall Perceptions of Resident Safety' were the domains with the highest proportions of positive answers (PPAs). For most staff categories, 'Staffing' was the domain with the lowest PPA. Support Staff showed significantly lower scores in the majority of domains (8/12). Shorter job tenure, fewer weekly working hours, working mostly during the day and working in highly specialized areas were associated with higher scores in several domains. Interventions to improve PSC must consider the differences between professional groups. Further research is needed to explore the relationship between job-related features and perceptions of patient safety among NH workers.
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Affiliation(s)
- Ilaria Tocco Tussardi
- Department of Diagnostics and Public Health, Section of Hygiene, University of Verona, 37134 Verona, Italy
| | - Lucia Cazzoletti
- Department of Diagnostics and Public Health, Section of Epidemiology and Medical Statistics, University of Verona, 37134 Verona, Italy
| | - Maria Elisabetta Zanolin
- Department of Diagnostics and Public Health, Section of Epidemiology and Medical Statistics, University of Verona, 37134 Verona, Italy
| | - Annarita Comini
- Department of Diagnostics and Public Health, Section of Hygiene, University of Verona, 37134 Verona, Italy
| | - Donatella Visentin
- Department of Prevention, Healthcare Trust of the Autonomous Province of Trento, 38123 Trento, Italy
| | - Emanuele Torri
- Clinical Governance Service, Healthcare Trust of the Autonomous Province of Trento, 38123 Trento, Italy
| | - Stefano Tardivo
- Department of Diagnostics and Public Health, Section of Hygiene, University of Verona, 37134 Verona, Italy
| | - Francesca Moretti
- Department of Neurosciences, Biomedicine and Movement, University of Verona, 37134 Verona, Italy
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Charlton K, Stagg H, Burrow E. The clinical effectiveness of a falls rapid response service, and sex differences of patients using the service: a cross-sectional study in an English ambulance trust. Br Paramed J 2023; 8:28-33. [PMID: 37284609 PMCID: PMC10240863 DOI: 10.29045/14784726.2023.6.8.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Background Falls in older adults are an important issue internationally. They occur from complex interactions between biological, environmental and activity-related factors. As the sexes age differently, there may be sex differences regarding falls. This study aimed to determine the clinical effectiveness of a falls rapid response service (FRRS) in an English ambulance trust and to identify sex differences between patients using the service. Methods A cross-sectional study between December 2018 and September 2020. Patients aged ≥ 60 years who had fallen within the study area were included. The FRRS comprised a paramedic and occupational therapist and responded 07:00-19:00, 7 days per week. Anonymised data regarding age, sex and conveyance were collected for all patients attended by the FRRS and standard ambulance crews. Clinical data regarding fall events were collected from consenting patients attended by the FRRS only. Results There were 1091 patients attended by the FRRS versus 4269 by standard ambulance crews. Patient characteristics were similar regarding age and sex. The FRRS consistently conveyed fewer patients versus standard ambulance crews (467/1091 (42.8%) v. 3294/4269 (77.1%), p = < 0.01). Clinical data were collected from 426/1091 patients attended by the FRRS. In these patients, women were more likely to reside alone than men (181/259 (69.8%) v. 86/167 (51.4%), p = < 0.01), and less likely to experience a witnessed fall (16.2% v. 26.3%, p = 0.01). Women had a higher degree of comorbidity specific to osteoarthritis and osteoporosis, while men were more likely to report a fear of falling score of 0 (35.3% v. 22.7%, p = < 0.01). Conclusion The FRRS is clinically effective regarding falls compared to standard ambulance crews. Sex differences existed between men and women using the FRRS, indicating women are further along the falls trajectory than men. Future research should focus on demonstrating the cost effectiveness of the FRRS and how to better meet the needs of older women who fall.
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Affiliation(s)
| | - Hayley Stagg
- North East Ambulance Service NHS Foundation Trust
| | - Emma Burrow
- North East Ambulance Service NHS Foundation Trust
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Sex Differences in Falls: The Mediating Role of Gait Stability Ratio and Body Balance in Vulnerable Older Adults. J Clin Med 2023; 12:jcm12020450. [PMID: 36675379 PMCID: PMC9864613 DOI: 10.3390/jcm12020450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
This study, conducted on a large sample of older adults at elevated fall risk (1), aimed to verify statistical differences in gait stability ratio (GSR) and body balance (BB) according to sex, (2) to examine and compare GSR and BB performance between older adult fallers and non-fallers, (3) to determine an association between GSR and BB according to the history of falls, and (4) to explore whether GSR and BB mediate the association between sex and falls. We included 619 individuals (69.8 ± 5.6 years) living in the Autonomous Region of Madeira, Portugal. The frequency of falls was obtained by self-report. BB was determined by the Fullerton Advanced Balance scale, while GSR was established by dividing cadence by gait speed and data collected during the 50-foot walk test. Males indicated a lower prevalence of falls in the last 12 months (23.6%), while females had a higher score (48.7%), as well as a lower balance performance (p < 0.001) and higher GSR scores (p < 0.001). Lower BB control (p < 0.001), as well as higher GSR, were more expressive for fallers (p < 0.001). We found a large, negative and significant correlation between GSR and BB for historical falls (r = −0.560; p < 0.001), and between male and female cohorts (r = −0.507; p < 0.001). The total effect of sex on falls mediated by GSR and BB was 16.4%. Consequently, GSR and BB mediated this association by approximately 74.0% and 22.5%, respectively.
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Lavon O, Cohen D. Safety Signal Evaluation of a Risk of Syncope and Dizziness Not Related to Bleeding or Stroke in Direct Oral Anticoagulant-treated Patients. Clin Ther 2023; 45:78-83. [PMID: 36653197 DOI: 10.1016/j.clinthera.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE In clinical studies, rivaroxaban treatment has been associated with increased incidence of syncope not related to bleeding, anemia, or stroke. The study objective was to evaluate the occurrence of dizziness and/or syncope not related to bleeding, anemia, or stroke in patients treated with direct oral anticoagulants (DOACs). METHODS A retrospective, observational, comparative study of adult patients diagnosed with atrial fibrillation and treated with DOACs was conducted using digital retrieval of medical records. Primary outcomes were an emergency department (ED) visit or hospitalization due to syncope, fall, or dizziness. Cases related to bleeding, anemia, or stroke were excluded. Separate examination of a sample of records validated the data. FINDINGS Of 6467 eligible patients, 256 (4%) were hospitalized or referred to the ED due to fall, syncope, or dizziness during a mean observation period of 20.1 months. After multivariate regression analysis, statistically independent risk factors were found to be age (hazard ratio [HR] = 1.04, P < 0.0001) and benzodiazepine use (HR = 1.33, P = 0.03). No statistically significant difference was found among the different DOAC types regarding the primary outcome (apixaban and rivaroxaban HR = 0.97, P = 0.85; dabigatran and rivaroxaban HR = 1.2, P = 0.386). IMPLICATIONS The study results failed to confirm the claimed association between the use of a DOAC and syncopal symptoms unrelated to bleeding, anemia, or stroke in this relatively large Israeli patient population. Age and benzodiazepine treatment were significant independent risk factors of these events.
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Affiliation(s)
- Ophir Lavon
- Clinical Pharmacology and Toxicology Unit, Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Daisy Cohen
- Clinical Pharmacology and Toxicology Unit, Carmel Medical Center, Haifa, Israel
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Prevalence of potentially inappropriate prescribing in older adults in Central and Eastern Europe: a systematic review and synthesis without meta-analysis. Sci Rep 2022; 12:16774. [PMID: 36202826 PMCID: PMC9537527 DOI: 10.1038/s41598-022-19860-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022] Open
Abstract
We aimed to systematically review the prevalence of potentially inappropriate prescribing (PIP) in older adults in Central and Eastern Europe (CEE) in all care settings. We searched Embase and MEDLINE (up to June 2019) and checked the reference lists of the included studies and relevant reviews. Eligible studies used validated explicit or implicit tools to assess the PIP prevalence in older adults in CEE. All study designs were considered, except case‒control studies and case series. We assessed the risk of bias using the Joanna Briggs Institute Prevalence Critical Appraisal Tool and the certainty of evidence using the GRADE approach. Meta-analysis was inappropriate due to heterogeneity in the outcome measurements. Therefore, we used the synthesis without meta-analysis approach-summarizing effect estimates method. This review included twenty-seven studies with 139,693 participants. Most studies were cross-sectional and conducted in high-income countries. The data synthesis across 26 studies revealed the PIP prevalence: the median was 34.6%, the interquartile range was 25.9-63.2%, and the range was 6.5-95.8%. The certainty of this evidence was very low due to the risk of bias, imprecision, and inconsistency. These findings show that PIP is a prevalent issue in the CEE region. Further well-designed studies conducted across countries are needed to strengthen the existing evidence and increase the generalizability of findings.
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Viana SDSC, Souza NPDS, Aliberti MJR, Jacob-Filho W. Use of potentially inappropriate medications and adverse events in older outpatients with acute conditions. EINSTEIN-SAO PAULO 2022; 20:eAO8024. [PMID: 35792759 PMCID: PMC9239534 DOI: 10.31744/einstein_journal/2022ao8024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To examine associations between potentially inappropriate medication, use and the risk of falls, unplanned hospitalization and death in older patients receiving initial care in a geriatric day hospital due to acute conditions. Methods Cohort study with older adults referred to a geriatric day hospital from 2014 to 2017 due to acute conditions. Patients were submitted to comprehensive geriatric assessment. Use of medications was analyzed according to Beers Criteria 2019. Outcome assessment was based on monthly follow-up telephone calls made over the course of one year. Results In this sample, 40.6% of patients had been prescribed at least one potentially inappropriate medication, particularly proton pump inhibitors (66.5%). Over the course of follow-up, 44.7% of patients receiving potentially inappropriate medications sustained at least one fall (p=0.0043) and 70% visited the emergency department (p=0.0452). These outcomes were more common among patients using two or more of drugs. Use of potentially inappropriate medication was associated with a 64% increase in the odds of unplanned hospitalization and a two-fold increase in risk of death. Conclusion Associations between potentially inappropriate medication use and unfavorable outcomes such as falls and unplanned hospitalizations within one year of admission to a geriatric day hospital support the application of Beers Criteria and emphasize the importance of periodic prescription review, deprescription and rational use of these drugs whenever possible.
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Experience and Appreciation of Health Care Teams Regarding a New Model of Pharmaceutical Care in Long-Term Care Settings. Can J Aging 2022; 41:421-430. [DOI: 10.1017/s0714980821000672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
In long-term care (LTC) homes, the management of frail older residents’ pharmacotherapy may be challenging for health care teams. A new pharmaceutical care model highlighting the recently expanded scope of pharmacists’ practice in Quebec, Canada, was implemented in two LTC homes. This study aimed to evaluate health care providers’ experience and satisfaction with this new practice model. Twenty-three semi-structured interviews were performed and analyzed thematically. Positive results of the model have been identified, such as increased timeliness of interventions. Barriers were encountered, such as lack of clarity regarding roles, and suboptimal communication. The increased involvement of pharmacists was perceived as useful in the context of scarce medical resources. Although requiring time and adjustments from health care teams, the new model seems to contribute to the health care providers’ work satisfaction and to positively influence the timeliness and quality of care offered to LTC residents.
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Hoedl M, Eglseer D, Bernet N, Everink I, Gordon AL, Lohrmann C, Osmancevic S, Saka B, Schols JMGA, Thomann S, Bauer S. Which factors influence the prevalence of institution-acquired falls? Results from an international, multi-center, cross-sectional survey. J Nurs Scholarsh 2021; 54:462-469. [PMID: 34919335 PMCID: PMC9542022 DOI: 10.1111/jnu.12758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Falls are a highly prevalent problem in hospitals and nursing homes with serious negative consequences such as injuries, increased care dependency, or even death. The aim of this study was to provide a comprehensive insight into institution-acquired fall (IAF) prevalence and risk factors for IAF in a large sample of hospital patients and nursing home residents among five different countries. DESIGN This study reports the outcome of a secondary data analysis of cross-sectional data collected in Austria, Switzerland, the Netherlands, Turkey, and the United Kingdom in 2017 and 2018. These data include 58,319 datapoints from hospital patients and nursing home residents. METHODS Descriptive statistics, statistical tests, logistic regression, and generalized estimating equation (GEE) models were used to analyze the data. FINDINGS IAF prevalence in hospitals and nursing homes differed significantly between the countries. Turkey (7.7%) had the highest IAF prevalence rate for hospitals, and Switzerland (15.8%) had the highest IAF prevalence rate for nursing homes. In hospitals, our model revealed that IAF prevalence was associated with country, age, care dependency, number of medical diagnoses, surgery in the last two weeks, and fall history factors. In nursing homes, care dependency, diseases of the nervous system, and fall history were identified as significant risk factors for IAF prevalence. CONCLUSIONS This large-scale study reveals that the most important IAF risk factor is an existing history of falls, independent of the setting. Whether a previous fall has occurred within the last 12 months is a simple question that should be included on every (nursing) assessment at the time of patient or resident admission. Our results guide the development of tailored prevention programs for persons at risk of falling in hospitals and nursing homes.
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Affiliation(s)
- Manuela Hoedl
- Medical University of Graz, Institute of Nursing Science, Graz, Austria
| | - Doris Eglseer
- Medical University of Graz, Institute of Nursing Science, Graz, Austria
| | - Niklaus Bernet
- Division of Nursing, Department of Health, Bern University of Applied Sciences, Bern, Switzerland
| | - Irma Everink
- Department Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK.,East Midlands Academic Health Sciences Network Patient Safety Collaborative, Nottingham, UK.,NIHR Applied Research Collaboration - East Midlands (ARC-EM), Nottingham, UK
| | - Christa Lohrmann
- Medical University of Graz, Institute of Nursing Science, Graz, Austria
| | | | - Bülent Saka
- Istanbul Faculty of Medicine, Department Internal Medicine, İstanbul Tıp Fakültesi Çapa - Fatih, Istanbul University, LIstanbul, Turkey
| | - Jos M G A Schols
- Department Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Silvia Thomann
- Division of Nursing, Department of Health, Bern University of Applied Sciences, Bern, Switzerland
| | - Silvia Bauer
- Medical University of Graz, Institute of Nursing Science, Graz, Austria
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Desmedt M, Petrovic M, Beuckelaere P, Vandijck D. Assessing Resident Safety Culture in Six Nursing Homes in Belgium. J Patient Saf 2021; 17:e1209-e1215. [PMID: 29596134 DOI: 10.1097/pts.0000000000000476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary aim was to measure resident safety culture in six nursing homes in northern Belgium (Flanders). In addition, differences in safety culture perceptions between professions were also examined. Finally, results of the present study were compared with the Nursing Home Comparative Database from the Agency for Healthcare Research and Quality (USA). METHODS A cross-sectional study was conducted by administering the Nursing Home Survey on Patient Safety Culture in six nursing homes in Belgium (Flanders). Each nursing home has 92 to 170 licensed nursing home beds. Data collection occurred between December 2016 and January 2017. RESULTS Highest mean scores were found for "feedback and communication about incidents" (mean [SD] = 4.20 [0.58]), "overall perceptions of resident safety" (mean [SD] = 4.07 [0.52]), and "supervisor expectations and actions promoting resident safety" (mean [SD] = 4.04 [0.70]). The lowest mean score was found for "staffing" (mean [SD] = 2.99 [0.61]). In addition, managers/supervisors scored significantly higher on all resident safety dimensions, with the exception of the dimensions "teamwork" and "supervisor expectations and actions promoting resident safety." Finally, the present study scored higher on the dimensions "teamwork," "nonpunitive response to mistakes," "handoffs," "feedback and communication about incidents," and "communication openness" than the benchmarking data from the Nursing Home Comparative Database. CONCLUSIONS More work is necessary to improve the safety of resident care in nursing homes, especially regarding staffing issues and turnover rates. The present research findings serve to shine a light on an often-overlooked patient population and emphasize the need to develop improvement strategies for preventing resident safety incidents in nursing homes.
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Affiliation(s)
- Melissa Desmedt
- From the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
| | - Mirko Petrovic
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Petra Beuckelaere
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dominique Vandijck
- From the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
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Milosevic V, Linkens A, Winkens B, Hurkens KPGM, Wong D, van Oijen BPC, van der Kuy HM, Mestres-Gonzalvo C. Fall incidents in nursing home residents: development of a predictive clinical rule (FINDER). BMJ Open 2021; 11:e042941. [PMID: 33941626 PMCID: PMC8098923 DOI: 10.1136/bmjopen-2020-042941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To develop (part I) and validate (part II) an electronic fall risk clinical rule (CR) to identify nursing home residents (NH-residents) at risk for a fall incident. DESIGN Observational, retrospective case-control study. SETTING Nursing homes. PARTICIPANTS A total of 1668 (824 in part I, 844 in part II) NH-residents from the Netherlands were included. Data of participants from part I were excluded in part II. PRIMARY AND SECONDARY OUTCOME MEASURES Development and validation of a fall risk CR in NH-residents. Logistic regression analysis was conducted to identify the fall risk-variables in part I. With these, three CRs were developed (ie, at the day of the fall incident and 3 days and 5 days prior to the fall incident). The overall prediction quality of the CRs were assessed using the area under the receiver operating characteristics (AUROC), and a cut-off value was determined for the predicted risk ensuring a sensitivity ≥0.85. Finally, one CR was chosen and validated in part II using a new retrospective data set. RESULTS Eleven fall risk-variables were identified in part I. The AUROCs of the three CRs form part I were similar: the AUROC for models I, II and III were 0.714 (95% CI: 0.679 to 0.748), 0.715 (95% CI: 0.680 to 0.750) and 0.709 (95% CI: 0.674 to 0.744), respectively. Model III (ie, 5 days prior to the fall incident) was chosen for validation in part II. The validated AUROC of the CR, obtained in part II, was 0.603 (95% CI: 0.565 to 0.641) with a sensitivity of 83.41% (95% CI: 79.44% to 86.76%) and a specificity of 27.25% (95% CI 23.11% to 31.81%). CONCLUSION Medication data and resident characteristics alone are not sufficient enough to develop a successful CR with a high sensitivity and specificity to predict fall risk in NH-residents. TRIAL REGISTRATION NUMBER Not available.
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Affiliation(s)
- Vanja Milosevic
- Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen and Heerlen, Limburg, The Netherlands
- Clinical Pharmacy, Elkerliek Hospital, Helmond, The Netherlands
| | - Aimee Linkens
- Internal Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
- Department of Hospital Pharmacy, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Bjorn Winkens
- Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Kim P G M Hurkens
- Geriatric Medicine, Department of Internal Medicine, Zuyderland Medisch Centrum, Heerlen, Limburg, The Netherlands
| | - Dennis Wong
- Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen and Heerlen, Limburg, The Netherlands
| | - Brigit P C van Oijen
- Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen and Heerlen, Limburg, The Netherlands
| | - Hugo M van der Kuy
- Department of Hospital Pharmacy, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Carlota Mestres-Gonzalvo
- Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
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13
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Sheikh Rezaei S, Šinkovec H, Schöberl A, Rinner C, Heinze G, Wolzt M, Gall W. Utilization of potentially inappropriate medication and risk of adverse drug events among older adults with chronic renal insufficiency: a population-wide cohort study. BMC Geriatr 2021; 21:117. [PMID: 33568102 PMCID: PMC7877037 DOI: 10.1186/s12877-021-02057-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of potentially inappropriate medication (PIM) in population of older adults may result in adverse drug events (ADE) already after short term exposure, especially when it is prescribed to patients with chronic kidney disease (CKD). In order to limit ADE in the treatment of older adults PIM lists have been constructed as a source of information for healthcare professionals. The aim of this study was to estimate the utilization of PIM and incidence of ADE in older adults (≥70 years) with CKD. METHODS We conducted a retrospective population-wide cohort study including patients from Lower Austria who were 70 years or older and diagnosed with CKD in the period from 2008 to 2011. Utilization of PIM was estimated from prescriptions filled by target population. We estimated risks of hospitalization due to ADE within 30 days after incident PIM prescription and compared them to a PIM-free control group by using marginal structural models (MSM). RESULTS We identified 11,547 patients (women: 50.6%, median age in 2008: 78 years) who fulfilled the inclusion criteria. In total 24.7 and 8.1% of all prescriptions from that period contained a medication with a substance listed in the EU (7)-PIM and AT-PIM list, respectively. Proton pump inhibitors and Ginkgo biloba were the most often prescribed PIMs in this population. 94.6 and 79.3% patients filled at least one EU(7)-PIM and AT-PIM prescription, respectively. Despite the relatively high utilization of PIM there was only a low incidence of clinically relevant ADE. No event type exceeded the threshold level of 1% in the analysis of risks of ADE after filling a prescription for PIM. Nevertheless, MSM analysis showed an increased risk for 11 drugs and reduced risk for 4 drugs. CONCLUSIONS PIM prescription was common among older adults with CKD, however, only a small number of these drugs eventually led to hospitalization due to ADE within 30 days after incident PIM was filled. In the absence of a clinically important PIM-related increase in risk, an assessment of potential ADE severity to a PIM list by using a warning score system seems prudent.
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Affiliation(s)
- Safoura Sheikh Rezaei
- Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Hana Šinkovec
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Alexander Schöberl
- Section for Medical Information Management, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Christoph Rinner
- Section for Medical Information Management, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Georg Heinze
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Walter Gall
- Section for Medical Information Management, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
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14
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Díaz LB, Casuso-Holgado MJ, Labajos-Manzanares MT, Barón-López FJ, Pinero-Pinto E, Romero-Galisteo RP, Moreno-Morales N. Analysis of Fall Risk Factors in an Aging Population Living in Long-Term Care Institutions in SPAIN: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197234. [PMID: 33022932 PMCID: PMC7579165 DOI: 10.3390/ijerph17197234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 12/17/2022]
Abstract
Falls in the elderly are associated with morbidity and mortality. Research about fall risk factors in Spanish care facilities is scarce. This study aimed to assess the prevalence of falls among residents living in long-term care Spanish institutions and to identify fall risk factors in this population. A nationwide retrospective cohort study was conducted in 113 centers. Persons over 70 years old who were living in a residential setting for at least 1 year were included. Simple and multiple regression analyses were conducted to estimate the associations between the main clinical variables registered in the databases and the presence of falls. A total of 2849 subjects were analyzed (mean age 85.21 years). The period prevalence of fallers in the last 12 months was 45.3%, with a proportion of recurrent fallers of 51.7%. The presence of falls was associated with lower Tinetti Scale scores (OR = 1.597, 95% CI: 1.280, 1.991; OR = 1.362, 95% CI: 1.134, 1.635), severe or moderate cognitive impairment (OR= 1.992, 95% CI: 1.472, 2.695; OR = 1.507, 95% CI: 1.231, 1.845, respectively), and polypharmacy (OR = 1.291, 95% CI: 1.039, 1.604). Fall prevention interventions should focus on the prevention of balance and cognitive deterioration and the improvement of these functions when possible. It should also focus on a periodical medication history revision aiming to avoid inappropriate prescriptions.
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Affiliation(s)
- Lourdes Bujalance Díaz
- Departament of Physiotherapy, DomusVi Remedios Center, Avda. Córdoba, 98, Aguilar de la Frontera, 14920 Córdoba, Spain;
| | - María Jesús Casuso-Holgado
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, C/Avicena s/n, 41009 Seville, Spain;
- Correspondence:
| | - María Teresa Labajos-Manzanares
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.T.L.-M.); (F.J.B.-L.); (R.P.R.-G.); (N.M.-M.)
| | - Francisco Javier Barón-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.T.L.-M.); (F.J.B.-L.); (R.P.R.-G.); (N.M.-M.)
| | - Elena Pinero-Pinto
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, C/Avicena s/n, 41009 Seville, Spain;
| | - Rita Pilar Romero-Galisteo
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.T.L.-M.); (F.J.B.-L.); (R.P.R.-G.); (N.M.-M.)
| | - Noelia Moreno-Morales
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (M.T.L.-M.); (F.J.B.-L.); (R.P.R.-G.); (N.M.-M.)
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15
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Lee SK, Ahn J, Shin JH, Lee JY. Application of Machine Learning Methods in Nursing Home Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6234. [PMID: 32867250 PMCID: PMC7503291 DOI: 10.3390/ijerph17176234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022]
Abstract
Background: A machine learning (ML) system is able to construct algorithms to continue improving predictions and generate automated knowledge through data-driven predictors or decisions. Objective: The purpose of this study was to compare six ML methods (random forest (RF), logistics regression, linear support vector machine (SVM), polynomial SVM, radial SVM, and sigmoid SVM) of predicting falls in nursing homes (NHs). Methods: We applied three representative six-ML algorithms to the preprocessed dataset to develop a prediction model (N = 60). We used an accuracy measure to evaluate prediction models. Results: RF was the most accurate model (0.883), followed by the logistic regression model, SVM linear, and polynomial SVM (0.867). Conclusions: RF was a powerful algorithm to discern predictors of falls in NHs. For effective fall management, researchers should consider organizational characteristics as well as personal factors. Recommendations for Future Research: To confirm the superiority of ML in NH research, future studies are required to discern additional potential factors using newly introduced ML methods.
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Affiliation(s)
- Soo-Kyoung Lee
- College of Nursing, Keimyung University, 1095, Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea;
| | - Jinhyun Ahn
- Department of Management Information Systems, Jeju National University, Jeju-do 63243, Korea;
| | - Juh Hyun Shin
- College of Nursing, Ewha Womans University, Seoul 03760, Korea;
| | - Ji Yeon Lee
- College of Nursing, Ewha Womans University, Seoul 03760, Korea;
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16
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Izza MAD, Lunt E, Gordon AL, Gladman JRF, Armstrong S, Logan P. Polypharmacy, benzodiazepines, and antidepressants, but not antipsychotics, are associated with increased falls risk in UK care home residents: a prospective multi-centre study. Eur Geriatr Med 2020; 11:1043-1050. [PMID: 32813154 PMCID: PMC7716922 DOI: 10.1007/s41999-020-00376-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/30/2020] [Indexed: 12/18/2022]
Abstract
Aim
To explore the link between polypharmacy, psychotropic medications, and falls risk in a cohort of UK care home residents. Findings
Polypharmacy and psychotropic drugs are predictive of falls in UK care home residents. Message Deprescribing interventions relating to psychotropic drugs should continue to be encouraged. Purpose Falls and polypharmacy are both common in care home residents. Deprescribing of medications in residents with increased falls risk is encouraged. Psychotropic medications are known to increase falls risk in older adults. These drugs are often used in care home residents for depression, anxiety, and behavioural and psychological symptoms of dementia. However, a few studies have explored the link between polypharmacy, psychotropic medications, and falls risk in care home residents. Methods This was a prospective cohort study of residents from 84 UK care homes. Data were collected from residents’ care records and medication administration records. Age, diagnoses, gender, number of medications, and number of psychotropic medications were collected at baseline and residents were monitored over three months for occurrence of falls. Logistic regression models were used to assess the effect of multiple medications and psychotropic medication on falls whilst adjusting for confounders. Results Of the 1655 participants, mean age 85 (SD 8.9) years, 67.9% female, 519 (31%) fell in 3 months. Both the total number of regular drugs prescribed and taking ≥ 1 regular psychotropic medication were independent risk factors for falling (adjusted odds ratio (OR) 1.06 (95% CI 1.03–1.09, p < 0.01) and 1.39 (95% CI 1.10–1.76, p < 0.01), respectively). The risk of falls was higher in those taking antidepressants (p < 0.01) and benzodiazepines (p < 0.01) but not antipsychotics (p > 0.05). Conclusion In UK care homes, number of medications and psychotropic medications (particularly antidepressants and benzodiazepines) predicted falls. This information can be used to inform prescribing and deprescribing decisions.
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Affiliation(s)
| | - Eleanor Lunt
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre - Musculoskeletal Theme, Nottingham, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre - Musculoskeletal Theme, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - John R F Gladman
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre - Musculoskeletal Theme, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Sarah Armstrong
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre - Musculoskeletal Theme, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK.,Nottingham CityCare Partnership, Nottingham, UK
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17
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Cateau D, Ballabeni P, Mena S, Bugnon O, Niquille A. Deprescribing in nursing homes: Protocol for nested, randomised controlled hybrid trials of deprescribing interventions. Res Social Adm Pharm 2020; 17:786-794. [PMID: 32622774 DOI: 10.1016/j.sapharm.2020.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Polypharmacy and the use of potentially inappropriate medication (PIMs) are frequent among nursing home (NH) residents, and are associated with adverse health outcomes like falls, hospitalisation and death. Deprescribing has been proposed as a way to curtail both problems; however, the best way to implement deprescribing and its real impact are still unclear. This article describes nested trials of two consecutive deprescribing interventions, the first at the NH level, and the second at the resident level. METHODS AND ANALYSIS The first intervention (QC-DeMo) will be a deprescribing module to be carried out in existing interprofessional quality circles in NHs, with the goal to develop a NH-wide deprescribing consensus. Its effects will be evaluated on the use of PIMs and on patient safety outcomes such as death, hospitalisation and falls. All NHs in the cantons of Vaud and Fribourg with an integrated pharmacy service will be eligible. The second intervention (IDeI), at the resident level, will be a deprescribing-focused medication review, resulting in the implementation of a deprescribing plan. Its effects will be evaluated on the use of PIMs and chronic medications, and on quality of life. This second trial will take place in the NHs allocated to the intervention group of the first trial. All residents of these NHs over 65 years old, living in the NH for at least 4 months, and taking 5 or more medications will be eligible to participate. Both trials will be hybrid effectiveness and implementation trials, aiming to understand the implementation process for the interventions, and to identify barriers and facilitators. ETHICS, REGISTRATION AND FUNDING Both trials were approved by the relevant ethics committee, registered on ClinicalTrials.gov (QC-DeMo: NCT03688542; IDeI: NCT03655405), and funded by the Swiss National Fund for Scientific Research.
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Affiliation(s)
- Damien Cateau
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Switzerland.
| | - Pierluigi Ballabeni
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Stephanie Mena
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Switzerland
| | - Olivier Bugnon
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Switzerland
| | - Anne Niquille
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Switzerland
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18
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Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
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19
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The relationship between common geriatric syndromes and potentially inappropriate medication use among older adults. Aging Clin Exp Res 2020; 32:681-687. [PMID: 31190200 DOI: 10.1007/s40520-019-01239-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/01/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIM Polypharmacy and inappropriate medication use in older adults is a major public health problem associated with morbidity and mortality. Aging is associated with metabolic changes and decreased drug clearance, increased drug-drug interactions, prescribing cascades, and potentially inappropriate medication (PIM) use. The purpose of this study was to evaluate the association between a common geriatric syndromes and PIM use among older adults. METHODS Study participants were recruited among patients admitted to Istanbul Medical School Geriatrics outpatient clinic between June 2000 and June 2014 and were evaluated retrospectively by a geriatrician using the patients' records according to Beers 2012 criteria. RESULTS Among the 667 enrolled patients, 421 (63.1%) were women and 246 (36.9%) were men. The use of PIM was not associated with age or sex. Polypharmacy (OR 4.86, 95% CI 3.25-7.27, p < 0.001), malnutrition (OR 2.69, 95% CI 1.52-4.76, p = 0.001), depression (OR 2.61, 95% CI 1.7-3.95, p < 0.001), presence of fall in the previous year (OR 2.24, 95% CI 1.51-3.32, p < 0.001), and dementia (OR 1.69, 95% CI 1.08-2.65, p = 0.021) were independently associated with the use of PIM. DISCUSSION/CONCLUSIONS The results of our study suggest that PIM use is independently associated with presence of polypharmacy, malnutrition, depression, falls and dementia in older outpatients. Identifying the association of inappropriate medication use with common geriatric syndromes in older people can help to prevent, delay, and reduce PIM use and related adverse health outcomes.
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20
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Hasan SS, Chang SH, Thiruchelvam K, Chong DWK, Babar ZU. Drug burden index, polypharmacy and patient health outcomes in cognitively intact older residents of aged care facilities in Malaysia. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- S. S. Hasan
- Department of Pharmacy University of Huddersfield Huddersfield UK
| | - S. H. Chang
- Department of Pharmacy Practice International Medical University Kuala Lumpur Malaysia
| | - K. Thiruchelvam
- Department of Pharmacy Practice International Medical University Kuala Lumpur Malaysia
| | - D. W. K. Chong
- Department of Pharmacy Practice International Medical University Kuala Lumpur Malaysia
| | - Z. U. Babar
- Department of Pharmacy University of Huddersfield Huddersfield UK
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21
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Resnick B, Boltz M, Galik E, Holmes S, Fix S, Zhu S. Gender Differences in Function, Physical Activity, Falls, Medication Use, and Life Satisfaction Among Residents in Assisted Living Settings. Res Gerontol Nurs 2020; 13:31-40. [PMID: 31584687 PMCID: PMC6980912 DOI: 10.3928/19404921-20190930-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/06/2019] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to test for gender differences among residents living in assisted living settings. This was a secondary data analysis using data from the first 64 facilities participating in the ongoing Function Focused Care for Assisted Living study using the Evidence Integration Triangle (FFC-AL-EIT). A total of 593 residents were recruited. Differences by gender with regard to function, physical activity, falls, total number of medications, and satisfaction with assisted living were tested using multivariate analysis of variance. There were 166 (28%) men and 427 (72%) women with a mean age of 88 (SD = 7.5 years). Participants had five (SD = 2) comorbidities and took on average 6.88 medications (SD = 3.47). Participants had moderate functional impairment with a mean of 64.13 (SD = 19.09) on the Barthel Index and engaged in 43.8 (SD = 76.12) minutes daily of moderate level physical activity. Women reported higher satisfaction with activities (4.32 [SD = 1.14]) than men (3.85 [SD = 1.51]), and women received more medications than men (7.09 [SD = 3.51] vs. 6.34 [SD = 3.31]). Current study findings suggest that deprescribing may be particularly important for women versus men and focusing on expanding activity options to include those preferred by men should be considered in assisted living settings. [Research in Gerontological Nursing, 13(1), 31-40.].
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22
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Risk factors associated with accidental falls among Italian nursing home residents: A longitudinal study (FRAILS). Geriatr Nurs 2019; 41:75-80. [PMID: 31296404 DOI: 10.1016/j.gerinurse.2019.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 11/21/2022]
Abstract
Older adults living in nursing homes (NHs) are at greater risk of injury resulting from a fall due to multiple factors, such as functional/cognitive impairment, postural instability, polytherapy, and psychotropic drugs. We aimed to assess characteristics of fallers, and investigate risk factors associated with falls among older NHs residents, through one-year longitudinal study. Demographic and clinical characteristics, number/typology of drugs, and fall occurrence were collected for each resident. We recruited 409 residents (82% women; 83 ± 9.4 years) in geriatric units (331, 81%) and in specialized dementia units (SDUs, 78%). 111 residents fell (27%), and 54 (48.6%) of them had an injury related to a fall. We detected an average of 1.3 falls (±0.48, range 1-10) per resident. Higher autonomy in activities of daily living, living in SDUs, and previous falls were significantly associated with falls. Thus, these findings should be considered as an alert to subsequent falls.
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23
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Fialová D, Brkić J, Laffon B, Reissigová J, Grešáková S, Dogan S, Doro P, Tasić L, Marinković V, Valdiglesias V, Costa S, Kostřiba J. Applicability of EU(7)-PIM criteria in cross-national studies in European countries. Ther Adv Drug Saf 2019; 10:2042098619854014. [PMID: 31258888 PMCID: PMC6591668 DOI: 10.1177/2042098619854014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/24/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The European Union (EU)(7)-PIM (potentially inappropriate medication) list presents the most comprehensive and up-to-date tool for evaluation of PIM prescribing in Europe; however, several country-specific studies have documented lower specificity of this list on pharmaceutical markets of some countries. The aim of our study was to describe approval rates and marketing of PIMs stated by EU(7)-PIM criteria in six EU countries [in comparison with the American Geriatric Society (AGS) Beers 2015 criteria]. METHODS Research teams of six EU countries (Czech Republic, Spain, Portugal, Serbia, Hungary and Turkey) participated in this study conducted by WG1b EU COST Action IS1402 group in the period October 2015-November 2018. Data on approval rates of PIMs and their availability on pharmaceutical markets have been obtained from databases of national drug-regulatory institutes and up-to-date drug compendia. The EU(7)-PIM list and AGS Beers 2015 Criteria (Section 1) were applied. RESULTS PIMs from EU(7)-PIM list were approved for clinical use more often than those from the AGS Beers 2015 criteria (Section 1). Approval rates for EU(7)-PIMs ranged from 42.8% in Serbia to 71.4% in Spain (for AGS criteria only from 36.4% to 65.1%, respectively). Higher percentages of approved PIMs were documented in Spain (71.4%), Portugal (67.1%) and Turkey (67.5%), lower in Hungary (55.5%), Czech Republic (50.2%) and Serbia (42.8%). The majority of approved PIMs were also currently marketed in all countries except in Turkey (19.8-21.7% not marketed PIMs) and less than 20% of PIMs were available as over-the-counter medications (except in Turkey, 46.4-48.1%). CONCLUSIONS The EU(7)-PIM list was created for utilization in European studies; however, applicability of this list is still limited in some countries, particularly in Eastern and Central Europe. The EU project EUROAGEISM H2020 (2017-2021) that focuses on PIM prescribing and regulatory measures in Central and Eastern European countries must consider these limits.
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Affiliation(s)
- Daniela Fialová
- Department of Social and Clinical Pharmacy,
Faculty of Pharmacy in Hradec Králové, Charles University, Heyrovského 1203,
Hradec Králové 500 05, Czech Republic
- Department of Geriatrics and Gerontology, 1st
Faculty of Medicine, Prague, Czech Republic
| | - Jovana Brkić
- Department of Social and Clinical Pharmacy,
Charles University, Czech Republic
| | - Blanca Laffon
- DICOMOSA Group, Department of Psychology,
Universidade da Coruña, A Coruña, Spain
| | - Jindra Reissigová
- Department of Statistical Modeling, The Czech
Academy of Sciences, Prague, Czech Republic
| | - Silvia Grešáková
- Department of Social and Clinical Pharmacy,
Charles University, Czech Republic
| | - Soner Dogan
- Department of Medical Biology, Yeditepe
University, Istanbul, Turkey
| | - Peter Doro
- Department of Clinical Pharmacy, University of
Szeged, Szeged, Hungary
| | - Ljiljana Tasić
- Department of Social Pharmacy and Pharmaceutical
Legislation, University of Belgrade, Belgrade, Serbia
| | - Valentina Marinković
- Department of Social Pharmacy and
Pharmaceutical Legislation, University of Belgrade, Belgrade, Serbia
| | - Vanessa Valdiglesias
- DICOMOSA Group, Department of Psychology,
Universidade da Coruña, A Coruña, Spain
| | - Solange Costa
- Department of Environmental Health, Portuguese
National Institute of Health, Porto, Portugal
- EPIUnit, University of Porto, Porto,
Portugal
| | - Jan Kostřiba
- Department of Social and Clinical Pharmacy,
Charles University, Czech Republic
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24
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Zimmermann J, Swora M, Pfaff H, Zank S. Organizational factors of fall injuries among residents within German nursing homes: secondary analyses of cross-sectional data. Eur J Ageing 2019; 16:503-512. [PMID: 31798374 DOI: 10.1007/s10433-019-00511-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The present study explored risk factors for fall injuries among nursing home residents, with a specific focus on the influence of organizational structure within facilities and their environment, which have been insufficiently investigated in the European context. For the analyses, secondary data collected in 2016 from 220 nursing homes across Germany were used. As a risk adjustment, two separate models were calculated for fall injuries among residents without (N = 7320) and with cognitive impairment (N = 8633). Results showed that residents without cognitive impairment had a decreased risk of fall injuries by 40.1% (P < 0.01), while those with cognitive impairment were at an increased risk of 23.8% (P < 0.05) when living in facilities that had dementia care units. However, disparities were found between federal states for both groups of residents (P < 0.05 vs. P < 0.01, respectively). Similarly, a higher proportion of registered nurses were associated with decreased risk of fall injuries among cognitively impaired residents (45.6%), which differed between federal states (P < 0.01). Facilities with homelike environments had a 16.7% (P < 0.05) lower risk of fall injuries among cognitively impaired residents than did traditionally organized facilities. Further research is needed to explain the disparities between German federal states using representative samples.
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Affiliation(s)
- Jaroslava Zimmermann
- 1Graduate School GROW - Gerontological Research on Well-Being, University of Cologne, Cologne, Germany
| | - Michael Swora
- 2Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences & Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- 2Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences & Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Susanne Zank
- 3Rehabilitative Gerontology, Faculty of Human Sciences, University of Cologne, Cologne, Germany
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Assessing Potentially Inappropriate Medications in Nursing Home Residents by NORGEP-NH Criteria. PHARMACY 2019; 7:pharmacy7010026. [PMID: 30841495 PMCID: PMC6473407 DOI: 10.3390/pharmacy7010026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Nursing home residents often have several conditions that necessitate the use of multiple medicines. This study investigates the prevalence of potentially inappropriate medications (PIMs) and its associations with sex, age, number of medicines, and study location (rural/urban). Methods: A cross-sectional study of long-term care residents from six nursing homes. Data was collected from medical records. We identified PIMs by applying the NORGEP-NH criteria. We conducted a Poisson regression analysis to investigate the association between the number of PIMs and sex, age, number of medicines, and study location. Results: We included 103 (18.4%) of 559 residents (68.0% women; mean age 83.2 years, mean number of daily used medicines 7.2 (SD = 3.6)). We identified PIMs in 56% of the residents (mean number = 1.10, SD = 1.26). In adjusted analyses, residents ≥80 years had 0.43 fewer PIMs compared to residents <80 years (p < 0.05). Residents using 4–6, 7–9, and 10+ medicines had on average 0.73, 1.06, and 2.11 more PIMs compared to residents using 0–3 medicines (p < 0.001), respectively. Conclusion: PIM use is prevalent among nursing home residents and is significantly associated with age and number of medicines. Our findings suggest a modest decrease in residents using PIMs compared to previous studies. Nevertheless, prescribing quality in nursing home residents in both urban and rural areas is still of great concern.
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Lapumnuaypol K, Thongprayoon C, Wijarnpreecha K, Tiu A, Cheungpasitporn W. Risk of fall in patients taking proton pump inhibitors: a meta-analysis. QJM 2019; 112:115-121. [PMID: 30364990 DOI: 10.1093/qjmed/hcy245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- K Lapumnuaypol
- From the Department of Internal Medicine, Albert Einstein Medical Center, PA, USA
| | - C Thongprayoon
- Department of Nephrology, Mayo Clinic, Nephrology and Hypertension, Rochester, MN, USA
| | - K Wijarnpreecha
- Department of Gastroenterology, Mayo Clinic Hospital Jacksonville, Gastroenterology, Jacksonville, FL, USA
| | - A Tiu
- From the Department of Internal Medicine, Albert Einstein Medical Center, PA, USA
| | - W Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, MS, USA
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Banu Z, Lim KK, Kwan YH, Yap KZ, Ang HT, Tan CS, Fong W, Thumboo J, Lee KH, Ostbye T, Low LL. Anti-hypertensive medications and injurious falls in an older population of low socioeconomic status: a nested case-control study. BMC Geriatr 2018; 18:195. [PMID: 30153807 PMCID: PMC6114512 DOI: 10.1186/s12877-018-0871-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/06/2018] [Indexed: 11/15/2022] Open
Abstract
Background This study aimed to determine whether the number of anti-hypertensive medication classes or any change in anti-hypertensive medication were associated with injurious fall among the community-dwelling older population of low socioeconomic status. Methods Using data from electronic medical records, we performed a nested case-control study among older Singapore residents (≥60) of low socioeconomic status (N = 210). Controls (n = 162) were matched to each case (n = 48) by age and gender. Variables with p < 0.10 in univariate analysis were included in multivariate analysis. We used conditional logistic regression to assess the associations of the number of anti-hypertensive medication classes and change in anti-hypertensive medication with injurious falls. We also performed stepwise regressions as sensitivity analyses. p < 0.05 was considered statistically significant. Results The mean (±SD) age of participants was 78.1 (± 8.33) years; 127 (60.4%) were female, 189 (90.0%) were Chinese. Those on ≥2 anti-hypertensive medication classes had an increased risk of experiencing an injurious fall compared to those not on any anti-hypertensive medication (OR = 5.45; CI:1.49–19.93; p = 0.01). Among those who were taking anti-hypertensive medication, those who had a change in the medication 180-day prior to injurious fall had a significantly increased risk of experiencing an injurious fall compared to those that did not report any change in anti-hypertensive medication (OR = 3.88; CI:1.23–12.19; p = 0.02). Sensitivity analyses generated consistent findings. Conclusion Both ≥2 anti-hypertensive medication classes and change in anti-hypertensive medication were associated with an increased risk of experiencing an injurious fall among the older population of low socioeconomic status. Our findings could guide prescribers to exercise caution in the initiation of anti-hypertensive medications or in making medication changes, especially among the older population of low socioeconomic status. Electronic supplementary material The online version of this article (10.1186/s12877-018-0871-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zafirah Banu
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Ka Keat Lim
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Kai Zhen Yap
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Hui Ting Ang
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Republic of Singapore.,Duke-NUS Medical School, Singapore, Republic of Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Republic of Singapore
| | - Kheng Hock Lee
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Republic of Singapore.,Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Truls Ostbye
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Republic of Singapore. .,Duke-NUS Medical School, Singapore, Republic of Singapore.
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Wang KN, Bell JS, Chen EYH, Gilmartin-Thomas JFM, Ilomäki J. Medications and Prescribing Patterns as Factors Associated with Hospitalizations from Long-Term Care Facilities: A Systematic Review. Drugs Aging 2018; 35:423-457. [PMID: 29582403 DOI: 10.1007/s40266-018-0537-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Residents of long-term care facilities (LTCFs) are at high risk of hospitalization. Medications are a potentially modifiable risk factor for hospitalizations. OBJECTIVE Our objective was to systematically review the association between medications or prescribing patterns and hospitalizations from LTCFs. METHODS We searched MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and International Pharmaceutical Abstracts (IPA) from inception to August 2017 for longitudinal studies reporting associations between medications or prescribing patterns and hospitalizations. Two independent investigators completed the study selection, data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Tools. RESULTS Three randomized controlled trials (RCTs), 22 cohort studies, five case-control studies, one case-time-control study and one case-crossover study, investigating 13 different medication classes and two prescribing patterns were included. An RCT demonstrated that high-dose influenza vaccination reduced all-cause hospitalization compared with standard-dose vaccination (risk ratio [RR] 0.93; 95% confidence interval [CI] 0.88-0.98). Another RCT found no difference in hospitalization rates between oseltamivir as influenza treatment and oseltamivir as treatment plus prophylaxis (treatment = 4.7%, treatment and prophylaxis = 3.5%; p = 0.7). The third RCT found no difference between multivitamin/mineral supplementation and hospitalization (odds ratio [OR] 0.94; 95% CI 0.74-1.20) or emergency department visits (OR 1.05; 95% CI 0.76-1.47). Two cohort studies demonstrated influenza vaccination reduced hospitalization. Four studies suggested polypharmacy and potentially inappropriate medications (PIMs) increased all-cause hospitalization. However, associations between polypharmacy (two studies), PIMs (one study) and fall-related hospitalizations were inconsistent. Inconsistent associations were found between psychotropic medications with all-cause and cause-specific hospitalizations (11 studies). Warfarin, nonsteroidal anti-inflammatory drugs, pantoprazole and vinpocetine but not long-term acetylsalicylic acid (aspirin), statins, trimetazidine, digoxin or β-blockers were associated with all-cause or cause-specific hospitalizations in single studies of specific resident populations. Most cohort studies assessed prevalent rather than incident medication exposure, and no studies considered time-varying medication use. CONCLUSION High-quality evidence suggests influenza vaccination reduces hospitalization. Polypharmacy and PIMs are consistently associated with increased all-cause hospitalization.
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Affiliation(s)
- Kate N Wang
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia.
| | - J Simon Bell
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Esa Y H Chen
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
| | - Julia F M Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Jenni Ilomäki
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Alves VC, Freitas WCJD, Ramos JS, Chagas SRG, Azevedo C, Mata LRFD. Actions of the fall prevention protocol: mapping with the classification of nursing interventions. Rev Lat Am Enfermagem 2017; 25:e2986. [PMID: 29267548 PMCID: PMC5738961 DOI: 10.1590/1518-8345.2394.2986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/07/2017] [Indexed: 11/21/2022] Open
Abstract
Objective: to analyze the correspondence between the actions contained in the fall prevention
protocol of the Ministry of Health and the Nursing Interventions Classification
(NIC) by a cross-mapping. Method: this is a descriptive study carried out in four stages: protocol survey,
identification of NIC interventions related to nursing diagnosis, the risk of
falls, cross-mapping, and validation of the mapping from the Delphi technique.
Results: there were 51 actions identified in the protocol and 42 interventions in the NIC.
Two rounds of mapping evaluation were carried out by the experts. There were 47
protocol actions corresponding to 25 NIC interventions. The NIC interventions that
presented the highest correspondence with protocol actions were: fall prevention,
environmental-safety control, and risk identification. Regarding the
classification of similarity and comprehensiveness of the 47 actions of the
protocol mapped, 44.7% were considered more detailed and specific than the NIC,
29.8% less specific than the NIC and 25.5% were classified as similar in
significance to the NIC. Conclusion: most of the actions contained in the protocol are more specific and detailed,
however, the NIC contemplates a greater diversity of interventions and may base a
review of the protocol to increase actions related to falls prevention..
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Affiliation(s)
- Vanessa Cristina Alves
- Undergraduate student in Nursing, Universidade Federal de São João Del Rei, Divinópolis, MG, Brazil
| | | | - Jeferson Silva Ramos
- Undergraduate student in Nursing, Universidade Federal de São João Del Rei, Divinópolis, MG, Brazil
| | | | - Cissa Azevedo
- Doctoral student, Escola de Enfermagem da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. Scholarship holder at Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
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Abstract
Background Patient safety culture concerns leader and staff interaction, attitudes, routines, awareness and practices that impinge on the risk of patient-adverse events. Due to their complex multiple diseases, nursing home patients are at particularly high risk of adverse events. Studies have found an association between patient safety culture and the risk of adverse events. This study aimed to investigate safety attitudes among healthcare providers in Norwegian nursing homes, using the Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV). We studied whether variations in safety attitudes were related to professional background, age, work experience and mother tongue. Methods In February 2016, 463 healthcare providers working in five nursing homes in Tønsberg, Norway, were invited to answer the SAQ-AV, translated and adapted to the Norwegian nursing home setting. Previous validation of the Norwegian SAQ-AV for nursing homes identified five patient safety factors: teamwork climate, safety climate, job satisfaction, working conditions and stress recognition. SPSS v.22 was used for statistical analysis, which included estimations of mean values, standard deviations and multiple linear regressions. P-values <0.05 were considered to be significant. Results Out of the 463 employees invited, 288 (62.2%) answered the questionnaire. Response rates varied between 56.9% and 72.2% across the five nursing homes. In multiple linear regression analysis, we found that increasing age and job position among the healthcare providers were associated with significantly increased mean scores for the patient safety factors teamwork climate, safety climate, job satisfaction and working conditions. Not being a Norwegian native speaker was associated with a significantly higher mean score for job satisfaction and a significantly lower mean score for stress recognition. Neither professional background nor work experience were significantly associated with mean scores for any patient safety factor. Conclusions Patient safety factor scores in nursing homes were poorer than previously found in Norwegian general practices, but similar to findings in out-of-hours primary care clinics. Patient safety culture assessment may help nursing home leaders to initiate targeted quality improvement interventions. Further research should investigate associations between patient safety culture and the occurrence of adverse events in nursing homes.
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Affiliation(s)
- Gunnar Tschudi Bondevik
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway.
| | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Bettina Sandgathe Husebø
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Municipality of Bergen, Bergen, Norway
| | - Ellen Catharina Tveter Deilkås
- The Norwegian Directorate of Health, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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