Medication safety: a protocol for nursing action. NICHE Faculty

AIDES to improving medication adherence in older adults

Medication regimens for older adults are often complex and costly. Designing, implementing, and maintaining an appropriate treatment regimen is challenging. The AIDES method is built on the principles of completing a comprehensive medication Assessment; partnering with patients to ensure Individualization of the regimen; choosing appropriate Documentation; providing accurate and ongoing Education tailored to the age group and needs of the individual; and continuing Supervision after initiation.

How graduate nurses use protocols to manage patients’ medications

AIMS AND OBJECTIVES

The aim of the study was to determine how graduate nurses use protocols in their medication management activities. The objectives were to: examine the extent of adherence to various protocols in relation to medication activities and determine how the ward environment impacts on graduate nurses' use of protocols to manage patients' medications.

BACKGROUND

Protocols help newly qualified nurses integrate new knowledge into practice and promote effective decision-making Design. A descriptive prospective qualitative design was used. Methods. Twelve graduate nurses involved in direct patient care in medical, surgical and specialty wards of a metropolitan teaching hospital participated in the study. Participant observations were conducted with the graduate nurses during a two-hour period when medications were being administered to patients. In-depth interviews were conducted with each nurse immediately after observations and demographic data were collected on participating nurses and patients in their care, including all medications prescribed. Protocols associated with medication management activities for the clinical settings were also transcribed.

RESULTS

Six themes were evident from the data: availability and use of protocols, scrutinizing patients' identity before medication administration, double-checking certain medications before administration, writing incident reports, following specific policies and timing the administration of medications.

CONCLUSION

Graduate nurses adhered to protocols if they were perceived not to impede with other nursing activities. Participants were also more likely to follow protocols if they felt encouraged to make their own decisions and if there was a decreased likelihood that disciplinary action would be involved.

RELEVANCE TO CLINICAL PRACTICE

Experienced health professionals should encourage graduate nurses to comply with medication protocols and to make clinically reasoned decisions about medication activities. By providing peer support and acting as role models, experienced health professionals can also demonstrate to graduate nurses how effective protocol use is an important component of quality patient care.

Intermediate care rapid assessment support service: an evaluation

This study evaluated a rapid assessment support service (RASS) in an inner city location. The evaluation focus was provided by the two main objectives of the service, i.e. to reduce the number of unnecessary emergency admissions for people over 65 years to acute hospitals and to support the assessment of people over 65 years in their own homes. A case study design was employed and methods included documentary analysis of patients' discharge summaries and/or notes, patient/carer diaries and patient/carer storytelling. The most common reasons for referral, and goals identified following assessment, were mobility/falls prevention and hygiene/activities of living. The key themes identified concerning the assessment process were partnership working, promoting patient independence relief for carers, integration of health and social care assessment, effective use of health-care professionals' time, integration with other services, satisfaction with the service and areas of dissatisfaction. Despite the methodological and practical limitations of this evaluation some of the early successes of this intermediate care service have been identified.

Nurses Improving Care for Healthsystem Elders (NICHE): using outcomes and benchmarks for evidenced-based practice

This article describes Nurses Improving Care for Healthsystem Elders (NICHE), a project begun in 1992 with four pilot hospitals. These pilot hospitals gathered baseline data using a geriatric institutional assessment profile (GIAP) with a pre- and postdesign to capture changes in staff attitudes, knowledge, and perceptions of the care of older adults. Based on the success of the pilot effort, NICHE, now in its eighth year, has evolved into a program that involves 32 health systems comprising 105 hospitals nationally. To date, more than 10,000 GIAPs have been collected by NICHE hospital staff. All NICHE settings are able to benchmark their GIAP data against comparable institutions (eg, urban, rural, university, community settings) to understand how they compare and then interpret the data at their unique sites. The opportunities for continuous quality improvement through the NICHE program are described.

Delirium in elderly patients: an overview of the state of the science

Delirium is a common and potentially preventable and reversible cause of functional disability, morbidity, mortality, and increased health care use among elderly individuals. Much has been learned about delirium in the past decade. Highlighted in this article are recent advances in the diagnosis of delirium, delirium in long-term care, use of health care resources, outcomes of delirium, etiologies, and interventions to prevent and treat delirium. Suggestions for future research also are proposed.