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Oh S, Sang E, Stawnychy MA, Garren P, You SB, O'Connor M, Hirschman KB, Hodgson N, Cranston T, Jablonski J, O'Brien K, Newcomb M, Spahr M, Bowles KH. Application of a Human Factors and Systems Engineering Approach to Explore Care Transitions of Sepsis Survivors From Hospital to Home Health Care. HUMAN FACTORS 2024; 66:2468-2484. [PMID: 38171592 DOI: 10.1177/00187208231222399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
STUDY AIM This study aims to describe the transition-in-care work process for sepsis survivors going from hospitals to home health care (HHC) and identify facilitators and barriers to enable practice change and safe care transitions using a human factors and systems engineering approach. BACKGROUND Despite high readmission risk for sepsis survivors, the transition-in-care work process from hospitals to HHC has not been described. METHODS We analyzed semi-structured needs assessment interviews with 24 stakeholders involved in transitioning sepsis survivors from two hospitals and one affiliated HHC agency participating in the parent implementation science study, I-TRANSFER. The qualitative data analysis was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) framework to describe the work process and identify work system elements. RESULTS We identified 31 tasks characterized as decision making, patient education, communication, information, documentation, and scheduling tasks. Technological and organizational facilitators lacked in HHC compared to the hospitals. Person and organization elements in HHC had the most barriers but few facilitators. Additionally, we identified specific task barriers that could hinder sepsis information transfer from hospitals to HHC. CONCLUSION This study explored the complex transition-in-care work processes for sepsis survivors going from hospitals to HHC. We identified barriers, facilitators, and critical areas for improvement to enable implementation and ensure safe care transitions. A key finding was the sepsis information transfer deficit, highlighting a critical issue for future study. APPLICATION We recommend using the SEIPS framework to explore complex healthcare work processes before the implementation of evidence-based interventions.
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McLean KJ, Haas M, Koenig J, Horvath M, Vigil M, Werner NE, Bishop L. "I'm dealing with a health care system that doesn't get it": Barriers and facilitators to inclusive healthcare for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1382-1393. [PMID: 38469707 PMCID: PMC11132937 DOI: 10.1177/13623613241236380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
LAY ABSTRACT Research has suggested that autistic adults may have a bigger chance of having mental health and physical health conditions such as depression, anxiety, sleep disorders, diabetes, obesity, and heart problems than adults without autism. Unfortunately, the unique healthcare needs of autistic adults are often overlooked, so it is not clear why autistic adults have worse health or what can be done to improve it. This study wants to find out the challenges autistic adults experience in taking care of their health and in going to different doctors. Researchers interviewed autistic adults across the country about their healthcare experiences. The interviewed autistic adults told the researchers about the barriers (things that did not help) and facilitators (things that did help) that impacted whether they received the care they needed. The researchers then organized what they learned from the autistic adults into a model called the Systems Engineering Initiative for Patient Safety model of work system and patient safety. This model explains how different parts of a healthcare system (person, tasks, technology and tools, environment, and organization) interact with one another and impact the healthcare experiences and outcomes of the patients in their care, like autistic adults. Overall, this study advocates for a systems-level approach to improving the healthcare experiences of autistic adults and their health outcomes.
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Affiliation(s)
| | - Meghan Haas
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
| | - Jamie Koenig
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
- Waisman Center, USA
| | - Megan Horvath
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
| | - Mariah Vigil
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University Bloomington, USA
| | - Lauren Bishop
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
- Waisman Center, USA
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Damiaens A, Van Hecke A, Foulon V. The RESPECT-brochure: Development of a tool to inform and empower residents and informal caregivers on the medicines' pathway in nursing homes. PEC INNOVATION 2023; 3:100195. [PMID: 37583597 PMCID: PMC10423891 DOI: 10.1016/j.pecinn.2023.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
Objective To develop and evaluate a tool to inform and empower nursing home (NH) residents and informal caregivers regarding the medicines' pathway. Methods Feedback on the tool's text, drafted by the research team, was collected from a professional organization; the lay-out was designed by an illustrator. The tool was pilot tested in NHs, focusing on feasibility, appropriateness, and meaningfulness. Semi-structured interviews and focus groups with residents, informal caregivers, and healthcare professionals were performed, as well as document analysis. Qualitative data were analyzed inductively. Results The RESPECT-brochure was developed and described each process of the medicines' pathway. Piloting showed that the tool was well perceived among residents and informal caregivers and offered opportunities to discuss medication-related questions and concerns, but that skills to tailor the conversation, especially given the changing NH population, a matching vision and local champion are required for the tool's uptake. Conclusion An informative and empowering tool has been successfully developed and pilot tested in NHs. Future research should investigate which strategies for implementation work best and can explore the impact of the tool's use in daily practice. Innovation The tool is the first in its kind and grants nursing home staff a new strategy to promote person-centered care.
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Affiliation(s)
- Amber Damiaens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, UGent, Department of Nursing director, Ghent University Hospital, Ghent, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Damiaens A, Strauven G, De Lepeleire J, Spinewine A, Foulon V. Stepwise development of a quality assessment instrument for the medicines' pathway in nursing homes. Res Social Adm Pharm 2023; 19:1446-1454. [PMID: 37482481 DOI: 10.1016/j.sapharm.2023.07.008] [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: 04/13/2023] [Revised: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Quality of care in nursing homes (NHs), and especially the quality of the medicines' pathway, remains a concern. OBJECTIVES To develop a quality assessment instrument to support NHs to evaluate the quality of their medicines' pathway, and to formulate recommendations for its implementation. METHODS A stepwise approach was used. First, a performance questionnaire for coordinating physicians, pharmacists and head nurses was developed, alongside a set of quality indicators (QIs). Next, a feasibility study regarding the QIs was performed in 4 NHs, followed by two pilot studies to optimize the instrument (in 14 and 9 NHs, respectively). Focus groups were held to formulate recommendations for instrument implementation. RESULTS The QI feasibility and first pilot study showed that the clarity and feasibility of QIs was insufficient. All QIs were therefore integrated in the performance questionnaire. The first pilot study also showed low response rates for certain questions in the performance questionnaire and resulted in a revision of questions with the aim to target the right type of healthcare professional, including quality coordinators and general practitioners. The final instrument targets all involved healthcare professionals (i.e. coordinating physicians, pharmacists, head nurses, general practitioners, and quality coordinators), and applies a sequential approach: a quick scan to set priorities, followed by a detailed scan to detect specific working points. The second pilot study showed appreciation for this approach. Last, five recommendations were made to promote the instrument's implementation. CONCLUSIONS A series of feasibility and pilot studies allowed the stepwise optimization of a quality assessment instrument for the medicines' pathway in NHs and resulted in modifications to improve its clarity and feasibility. Participants' recommendations will promote the successful implementation of the quality assessment instrument.
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Affiliation(s)
- Amber Damiaens
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Herestraat 49 - O&N II - Box 521, B-3000, Leuven, Belgium.
| | - Goedele Strauven
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Herestraat 49 - O&N II - Box 521, B-3000, Leuven, Belgium
| | - Jan De Lepeleire
- KU Leuven, Department of Public Health and Primary Care, Kapucijnenvoer 7 - Blok H - Box 7001, B-3000, Leuven, Belgium
| | - Anne Spinewine
- UCLouvain, Louvain Drug Research Institute, Avenue Mounier 72/B1.72.02, B-1200, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur, Pharmacy Department, Avenue Dr G Therasse 1, B-5530, Yvoir, Belgium
| | - Veerle Foulon
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Herestraat 49 - O&N II - Box 521, B-3000, Leuven, Belgium
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Damiaens A, Van Hecke A, Foulon V. Medication Decision-Making and the Medicines' Pathway in Nursing Homes: Experiences and Expectations of Involvement of Residents and Informal Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5936. [PMID: 37297540 PMCID: PMC10253180 DOI: 10.3390/ijerph20115936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Information on how residents and their informal caregivers are involved in the medicines' pathway in nursing homes is scarce. Likewise, it is not known how they would prefer to be involved therein. METHODS A generic qualitative study using semi-structured interviews with 17 residents and 10 informal caregivers from four nursing homes was performed. Interview transcripts were analyzed using an inductive thematic framework. RESULTS Four themes were derived to describe resident and informal caregiver involvement in the medicines' pathway. First, residents and informal caregivers show behaviors of involvement across the medicines' pathway. Second, their attitude towards involvement was mainly one of resignation, but variation was noted in their involvement preferences, ranging from minimal information to active participation needs. Third, institutional and personal factors were found to contribute to the resigned attitude. Last, situations were identified that drive residents and informal caregivers to act, regardless of their resigned attitude. CONCLUSIONS Resident and informal caregiver involvement in the medicines' pathway is limited. Nevertheless, interviews show that information and participation needs are present and show potential for residents' and informal caregivers' contribution to the medicines' pathway. Future research should explore initiatives to increase the understanding and acknowledgement of opportunities for involvement and to empower residents and informal caregivers to take on their roles.
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Affiliation(s)
- Amber Damiaens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Ann Van Hecke
- Department of Nursing Director, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
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Evaluating Patient Identification Practices During Intrahospital Transfers: A Human Factors Approach. J Patient Saf 2023; 19:117-127. [PMID: 36170519 DOI: 10.1097/pts.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Reliable patient identification is essential for safe care, and failures may cause patient harm. Identification can be interfered with by system factors, including working conditions, technology, organizational barriers, and inadequate communications protocols. The study aims to explore systems factors contributing to patient identification errors during intrahospital transfers. METHODS We conducted a qualitative study through direct observation and interviews with porters during intrahospital patient transfers. Data were analyzed using the Systems Engineering Initiative for Patient Safety human factors model. The patient transfer process was mapped and compared with the institutional Positive Patient Identification policy. Potential system failures were identified using a Failure Modes and Effects Analysis. RESULTS A total of 60 patient transfer handovers were observed. In none of the evaluable cases observed, patient identification was conducted correctly according to the hospital policy at every step of the process. The principal system factor responsible was organizational failure, followed by technology and team culture issues. The Failure Modes and Effects Analysis methodology revealed that miscommunication between staff and lack of key patient information put patient safety at risk. CONCLUSIONS Patient identification during intrahospital patient transfer is a high-risk event because several factors and many people interact. In this study, the disconnect between the policy and the reality of the workplace left staff and patients vulnerable to the consequences of misidentification. Where a policy is known to be substantially different from work as done, urgent revision is required to eliminate the serious risks associated with the unguided evolution of working practice.
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Smith CA, Masters PR. College students and patient work: Health information management by emerging young adults. LIBRARY & INFORMATION SCIENCE RESEARCH 2023. [DOI: 10.1016/j.lisr.2022.101216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Damiaens A, Van Hecke A, De Lepeleire J, Foulon V. Resident and informal caregiver involvement in medication-related decision-making and the medicines' pathway in nursing homes: experiences and perceived opportunities of healthcare professionals. BMC Geriatr 2022; 22:81. [PMID: 35081924 PMCID: PMC8793219 DOI: 10.1186/s12877-022-02773-6] [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: 08/13/2021] [Accepted: 01/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Person-centered care has been shown to be beneficial for nursing home residents. The know-how and attitude of healthcare professionals, however, can make its implementation difficult. Also, research on person-centered care with regard to medication decision-making and the medicines' pathway in nursing homes is lacking. This study aimed to provide an understanding of healthcare professionals' attitudes and perspectives on current resident and informal caregiver involvement in medication decision-making and the medicines' pathway in nursing homes. METHODS A qualitative, explorative study using semi-structured interviews with a sample of 25 healthcare professionals from four different nursing homes was performed. Interview transcripts were analyzed by means of an inductive thematic framework. RESULTS Three overarching domains were identified: 1) features of, 2) drivers and barriers for, and 3) perceived consequences of resident and informal caregiver involvement in medication decision-making and the medicines' pathway. Involvement was mainly initiated by residents and informal caregivers themselves, pointing towards information and participation needs among both groups. Nevertheless, actions of healthcare professionals towards resident and informal caregiver involvement were mainly reactive and fragmentary. Their actions were influenced by the perception of residents and informal caregivers' desire and capabilities to be involved, the perception of their own professional role, but also by organizational factors such as the nursing home's philosophy. Furthermore, organizational concerns tempered the motivation to provide residents and informal caregivers with more medication-related responsibilities. CONCLUSIONS Resident and informal caregiver involvement in medication decision-making and the medicines' pathway remains limited in nursing homes. Information and participation needs of residents and informal caregivers were not fully acknowledged by healthcare professionals. As such, we can conclude that there is a need for initiatives, both on an individual and on an organizational level, to create and improve awareness on opportunities to improve resident and informal caregiver involvement in medication decision-making and the medicines' pathway.
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Affiliation(s)
- Amber Damiaens
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N II - Herestraat 49 - Box 521, B-3000, Leuven, Belgium.
| | - Ann Van Hecke
- Department of Nursing director, Ghent University Hospital, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, UGent, Corneel Heymanslaan 10, B- 9000, Ghent, Belgium
| | - Jan De Lepeleire
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7 - Blok H - Box 7001, B-3000, Leuven, Belgium
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N II - Herestraat 49 - Box 521, B-3000, Leuven, Belgium
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Holden RJ, Abebe E, Russ-Jara AL, Chui MA. Human factors and ergonomics methods for pharmacy research and clinical practice. Res Social Adm Pharm 2021; 17:2019-2027. [PMID: 33985892 PMCID: PMC8603214 DOI: 10.1016/j.sapharm.2021.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Human factors and ergonomics (HFE) is a scientific and practical human-centered discipline that studies and improves human performance in sociotechnical systems. HFE in pharmacy promotes the human-centered design of systems to support individuals and teams performing medication-related work. OBJECTIVE To review select HFE methods well suited to address pharmacy challenges, with examples of their application in pharmacy. METHODS We define the scope of HFE methods in pharmacy as applications to pharmacy settings, such as inpatient or community pharmacies, as well as medication-related phenomena such as medication safety, adherence, or deprescribing. We identify and present seven categories of HFE methods suited to widespread use for pharmacy research and clinical practice. RESULTS Categories of HFE methods applicable to pharmacy include work system analysis; task analysis; workload assessment; medication safety and error analysis; user-centered and participatory design; usability evaluation; and physical ergonomics. HFE methods are used in three broad phases of human-centered design and evaluation: study; design; and evaluation. The most robust applications of HFE methods involve the combination of HFE methods across all three phases. Two cases illustrate such a comprehensive application of HFE: one case of medication package, label, and information design and a second case of human-centered design of a digital decision aid for medication safety. CONCLUSIONS Pharmacy, including the places where pharmacy professionals work and the multistep process of medication use across people and settings, can benefit from HFE. This is because pharmacy is a human-centered sociotechnical system with an existing tradition of studying and analyzing the present state, designing solutions to problems, and evaluating those solutions in laboratory or practice settings. We conclude by addressing common concerns about the implementation of HFE methods and urge the adoption of HFE methods in pharmacy.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Center for Aging Research, Regenstrief Institute, Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
| | - Ephrem Abebe
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Alissa L Russ-Jara
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Michelle A Chui
- Social & Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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Wheway JL, Jun GT. Adopting systems models for multiple incident analysis: utility and usability. Int J Qual Health Care 2021; 33:6369017. [PMID: 34508632 DOI: 10.1093/intqhc/mzab135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/09/2021] [Accepted: 09/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study aims to present two system models widely used in Human Factors and Ergonomics (HF/E) and evaluate whether the models are adoptable to England's national patient safety team in improving the exploration and understanding of multiple incident reports of an active patient safety issue and the development of the remedial actions for a potential National Patient Safety Alert. The existing process of examining multiple incidents is based on inductive thematic analysis and forming the remedial actions is based on barrier analysis of intelligence on potential solutions. However, no formal systems models evaluated in this study have been used. METHODS AcciMap and Systems Engineering Initiative for Patient Safety (SEIPS) were selected, applied and evaluated to the analysis of two different sets of patient safety incidents: (i) incidents concerning ingestion of superabsorbent polymer granules and (ii) incidents concerning the interruption in use of High Nasal Flow Oxygen. The first set was analysed by the first author and the utility and usability were reflected. The second set was analysed collectively by a purposeful sample of patient safety team members, who create the National Patient Safety Alerts from incident-level data and information. All of them attended a 30-min video-based training and a 1.5 h case-based online workshop. Post-workshop individual interviews were conducted to evaluate their perceived utility and usability of each model. RESULTS The patient safety team showed overwhelming support for the utility of the system models as a 'framework' that provides a systematic, structured way of looking at an issue and examining the causes, whilst also sharing concerns regarding their usability. AcciMap was viewed useful particularly in providing a visual comprehensive overview of the issue but considered chaotic by some participants due to many arrows between factors. SEIPS was perceived easier to understand due to the familiarity of the structure (Donbedian's model), but the non-hierarchical format of SEIPS was considered less useful. CONCLUSIONS The participants of the study agreed with the high level of utility of both models for their unique strengths, but shared some concern for the usability of them in terms of complexity and further training/coaching time would be required to adopt these models in their daily practices. It is recommended that the gap between HF/E practitioners and patient safety practitioners can be narrowed by strengthening education, and coaching and mentoring relationships between the two groups, led by the increasing number of healthcare practitioners who embrace their membership to HF/E practice.
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Affiliation(s)
- Jayne L Wheway
- Patient Safety Team, NHS England & NHS Improvement, London, UK
| | - Gyuchan Thomas Jun
- Human Factors and Complex Systems Research Group, School of Design and Creative Arts, Loughborough University, Epinal Way, Loughborough, Leicestershire LE11 3TU, UK
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Spinewine A, Evrard P, Hughes C. Interventions to optimize medication use in nursing homes: a narrative review. Eur Geriatr Med 2021; 12:551-567. [PMID: 33751478 PMCID: PMC8149362 DOI: 10.1007/s41999-021-00477-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/25/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Polypharmacy, medication errors and adverse drug events are frequent among nursing home residents. Errors can occur at any step of the medication use process. We aimed to review interventions aiming at optimization of any step of medication use in nursing homes. METHODS We narratively reviewed quantitative as well as qualitative studies, observational and experimental studies that described interventions, their effects as well as barriers and enablers to implementation. We prioritized recent studies with relevant findings for the European setting. RESULTS Many interventions led to improvements in medication use. However, because of outcome heterogeneity, comparison between interventions was difficult. Prescribing was the most studied aspect of medication use. At the micro-level, medication review, multidisciplinary work, and more recently, patient-centered care components dominated. At the macro-level, guidelines and legislation, mainly for specific medication classes (e.g., antipsychotics) were employed. Utilization of technology also helped improve medication administration. Several barriers and enablers were reported, at individual, organizational, and system levels. CONCLUSION Overall, existing interventions are effective in optimizing medication use. However there is a need for further European well-designed and large-scale evaluations of under-researched intervention components (e.g., health information technology, patient-centered approaches), specific medication classes (e.g., antithrombotic agents), and interventions targeting medication use aspects other than prescribing (e.g., monitoring). Further development and uptake of core outcome sets is required. Finally, qualitative studies on barriers and enablers for intervention implementation would enable theory-driven intervention design.
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Affiliation(s)
- Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, Woluwe-Saint-Lambert, 1200, Brussels, Belgium.
- Pharmacy Department, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Perrine Evrard
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, Woluwe-Saint-Lambert, 1200, Brussels, Belgium
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, UK
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Gilson AM, Xiong KZ, Stone JA, Jacobson N, Chui MA. A pharmacy-based intervention to improve safe over-the-counter medication use in older adults. Res Social Adm Pharm 2021; 17:578-587. [PMID: 32444347 PMCID: PMC8121184 DOI: 10.1016/j.sapharm.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND For older adults, health risks from inappropriate use of over-the-counter (OTC) medications represent a prevalent clinical and public health challenge. Focus groups with pharmacists led to the identification of a number of systems barriers to pharmacists supporting the safe selection and use of OTC medications by this population. Such feedback informed the development of the Senior Section™, a physical redesign that located a curated inventory of lower-risk OTC medications proximal to the prescription department. OBJECTIVES To determine whether implementation of the Senior Section resulted in improvements to the ability of pharmacy staff to engage with older adult patients to support OTC medication safety issues. METHODS A qualitative approach, in which pharmacy staff from 4 pharmacies within a single chain participated in a semi-structured interview, was used to evaluate the implementation of the Senior Section in their pharmacies. Interview transcripts underwent a deductive and iterative content analysis. RESULTS Eight pharmacists and 5 technicians were interviewed. They viewed the Senior Section as contributing to notable improvements in proximity, medication safety, convenience, and patient selection behaviors. The Senior Section's safer OTC inventory and its sectional layout, its relationship to the prescription department, and its signage served to enhance its usefulness as an OTC safety improvement intervention. Moreover, it functioned beneficially while streamlining the coordination of services with between pharmacists and technicians, and did not interfere with existing pharmacy workflows. CONCLUSIONS Pharmacy staff believed that the Senior Section facilitated their ability to engage with older adults to support safe OTC selection and use and thus to reduce OTC-related harms.
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Affiliation(s)
- Aaron M Gilson
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA.
| | - Ka Z Xiong
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA.
| | - Jamie A Stone
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA.
| | - Nora Jacobson
- Institute for Clinical and Translational Research, Community Academic Partnerships Program, University of Wisconsin-Madison School of Nursing, 701 Highland Ave, Madison, WI, 53705, USA.
| | - Michelle A Chui
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA; Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA.
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