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Fuller AEC, Guirguis LM, Sadowski CA, Makowsky MJ. Evaluation of Medication Incidents in a Long-term Care Facility Using Electronic Medication Administration Records and Barcode Technology. Sr Care Pharm 2022; 37:421-447. [DOI: 10.4140/tcp.n.2022.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective To describe the frequency, type, and severity of reported medication incidents that occurred at a long-term care facility (LTCF) despite electronic medication administration record and barcode-assisted medication administration (eMAR-BCMA) use. The study also contains
analysis for the contribution of staff workarounds to reported medication administration errors (MAEs) using an established typology for BCMA workarounds, characterize if the eMAR-BCMA technology contributed to MAEs, and explore characteristics influencing incident severity. Design
Retrospective incident report review. Setting A 239-bed LTCF in Alberta, Canada, that implemented eMAR-BCMA in 2013. Participants 270 paper-based, medication incident reports submitted voluntarily between June 2015 and October 2017. Interventions
None. Results Most of the 264 resident-specific medication incidents occurred during the administration (71.9%, 190/264) or dispensing (28.4%, 75/264) phases, and 2.3% (6/264) resulted in temporary harm. Medication omission (43.7%, 83/190) and incorrect time (22.6%,
43/190) were the most common type of MAE. Workarounds occurred in 41.1% (78/190) of MAEs, most commonly documenting administration before the medication was administered (44.9%, 35/78). Of the non-workaround MAEs, 52.7% (59/112) were notassociated with the eMAR-BCMA technology, while 26.8%
(30/112) involved system design shortcomings, most notably lack of a requirement to scan each medication pouch during administration. MAEs involving workarounds were less likely to reach the resident (74.4 vs 88.8%; relative risk = 0.84, 95% CI 0.72-0.97). Conclusion Administration
and dispensing errors were the most reported medication incidents. eMAR-BCMA workarounds, and design shortcomings were involved in a large proportion of reported MAEs. Attention to optimal eMAR-BCMA use and design are required to facilitate medication safety in LTCFs.
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Affiliation(s)
- Andrew E. C. Fuller
- University of Alberta, College of Health Sciences, Edmonton, Alberta, Canada
| | - Lisa M. Guirguis
- University of Alberta, College of Health Sciences, Edmonton, Alberta, Canada
| | - Cheryl A. Sadowski
- University of Alberta, College of Health Sciences, Edmonton, Alberta, Canada
| | - Mark J. Makowsky
- University of Alberta, College of Health Sciences, Edmonton, Alberta, Canada
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Kruse CS, Mileski M, Syal R, MacNeil L, Chabarria E, Basch C. Evaluating the relationship between health information technology and safer-prescribing in the long-term care setting: A systematic review. Technol Health Care 2021; 29:1-14. [PMID: 32894257 DOI: 10.3233/thc-202196] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The prevalence of health information technology (HIT) as an adjunct to increase safety and quality in healthcare applications is well known. There is a relationship between the use of HIT and safer-prescribing practices in long-term care. OBJECTIVE The objective of this systematic review is to determine an association between the use of HIT and the improvement of prescription administration in long-term care facilities. METHODS A systematic review was conducted using the MEDLINE and CINAHL databases. With the use of certain key terms, 66 articles were obtained. Each article was then reviewed by two researchers to determine if the study was germane to the research objective. If both reviewers agreed with using the article, it became a source for our review. The review was conducted and structured based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS The researchers identified 14 articles to include in a group for analysis from North America, Europe, and Australia. Electronic health records and electronic medication administration records were the two most common forms of technological interventions (6 of 14, 43%). Reduced risk, decreased error, decreased missed dosage, improved documentation, improved clinical process, and stronger clinical focus comprised 92% of the observations. CONCLUSIONS HIT has shown beneficial effects for many healthcare organizations. Long-term care facilities that implemented health information technologies, have shown reductions in adverse drug events caused by medication errors overall reduced risk to the organization. The implementation of new technologies did not increase the time nurses spent on medication rounds.
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Dugré N, Bell JS, Hopkins RE, Ilomäki J, Chen EYH, Corlis M, Van Emden J, Hogan M, Sluggett JK. Impact of Medication Regimen Simplification on Medication Incidents in Residential Aged Care: SIMPLER Randomized Controlled Trial. J Clin Med 2021; 10:jcm10051104. [PMID: 33800845 PMCID: PMC7961370 DOI: 10.3390/jcm10051104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 01/03/2023] Open
Abstract
In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we investigated the impact of a structured medication regimen simplification intervention on medication incidents in residential aged care facilities (RACFs) over a 12-month follow-up. A clinical pharmacist applied the validated 5-step Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) for 96 of the 99 participating residents in the four intervention RACFs. The 143 participating residents in the comparison RACFs received usual care. Over 12 months, medication incident rates were 95 and 66 per 100 resident-years in the intervention and comparison groups, respectively (adjusted incident rate ratio (IRR) 1.13; 95% confidence interval (CI) 0.53-2.38). The 12-month pre/post incident rate almost halved among participants in the intervention group (adjusted IRR 0.56; 95%CI 0.38-0.80). A significant reduction in 12-month pre/post incident rate was also observed in the comparison group (adjusted IRR 0.67, 95%CI 0.50-0.90). Medication incidents over 12 months were often minor in severity. Declines in 12-month pre/post incident rates were observed in both study arms; however, rates were not significantly different among residents who received and did not receive a one-off structured medication regimen simplification intervention.
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Affiliation(s)
- Nicolas Dugré
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- Faculty of Pharmacy, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Clinique Universitaire de Médecine Familiale Sacré-Coeur, Montréal, QC H3M 3A9, Canada
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia
- Correspondence: ; Tel.: +61-3-9903-9533
| | - Ria E. Hopkins
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Esa Y. H. Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia
| | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia
| | - Michelle Hogan
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia
| | - Janet K. Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- UniSA Allied Health and Human Performance Unit, City East campus, University of South Australia, Adelaide, SA 5001, Australia
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Trakulsunti Y, Antony J, Edgeman R, Cudney B, Dempsey M, Brennan A. Reducing pharmacy medication errors using Lean Six Sigma: A Thai hospital case study. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2021. [DOI: 10.1080/14783363.2021.1885292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Yaifa Trakulsunti
- School of Social Science, Edinburgh Business School, Heriot-Watt University, Edinburgh, Scotland, UK
| | - Jiju Antony
- School of Social Science, Edinburgh Business School, Heriot-Watt University, Edinburgh, Scotland, UK
| | - Rick Edgeman
- Management Department, Robbins College of Business & Entrepreneurship, Fort Hays State University, Hays, KS, USA
| | - Beth Cudney
- Department of Engineering Management & Systems Engineering, Missouri University of Science & Technology, Rolla, MI, USA
| | - Mary Dempsey
- Engineering & Informatics, National University of Ireland, Galway, Republic of Ireland
| | - Atrracta Brennan
- Engineering & Informatics, National University of Ireland, Galway, Republic of Ireland
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So KH, Ting CW, Lee CP, Lam TTN, Chiang SC, Cheung YT. Medication Management Service for Old Age Homes in Hong Kong Using Information Technology, Automation Technology, and the Internet of Things: Pre-Post Interventional Study. JMIR Med Inform 2021; 9:e24280. [PMID: 33565993 PMCID: PMC7904397 DOI: 10.2196/24280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Innovation in technology and automation has been increasingly used to improve conventional medication management processes. In Hong Kong, the current practices of medication management in old age homes (OAHs) are time consuming, labor intensive, and error prone. To address this problem, we initiated an integrated medication management service combining information technology, automation technology, and the Internet of Things in a cluster network of OAHs. Objective This pilot study aimed to evaluate the impact of the medication management program on (1) medication management efficiency, (2) medication safety, and (3) drug wastage in OAHs. We compared the time efficiency and the reductions in medication errors and medication wastage in OAHs before and at least 2 weeks after the implementation of the program. Methods From November 2019 to February 2020, we recruited 2 OAHs (serving 178 residents) in Hong Kong into the prospective, pre-post interventional study. The interventional program consisted of electronic medication profiles, automated packaging, and electronic records of medication administration. Using 3-way analysis of variance, we compared the number of doses prepared and checked in 10-minute blocks before and after implementation. We received anonymous reports of medication errors from OAH staff and analyzed the results with the Fisher exact test. We also calculated the quantity and cost of wasted medications from drug disposal reports. Results The number of doses prepared and checked in 10-minute blocks significantly increased postimplementation (pre: 41.3, SD 31.8; post: 70.6, SD 22.8; P<.001). There was also a significant reduction in medication errors (pre: 10/9504 doses, 0.1%; post: 0/5731 doses; P=.02). The total costs of wasted medications during January 2020 in OAH 1 (77 residents) and OAH 2 (101 residents) were HK $2566.03 (US $328.98) and HK $5249.48 (US $673.01), respectively. Conclusions Our pilot study suggested that an innovative medication management program with information technology, automation technology, and Internet of Things components improved the time efficiency of medication preparation and medication safety for OAHs. It is a promising solution to address the current limitations in medication management in OAHs in Hong Kong.
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Affiliation(s)
- Kei Hong So
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong (China).,Hong Kong Pharmaceutical Care Foundation, Hong Kong, Hong Kong (China)
| | - Cheuk Wun Ting
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong (China)
| | - Chui Ping Lee
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong (China)
| | - Teddy Tai-Ning Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong (China)
| | - Sau Chu Chiang
- Hong Kong Pharmaceutical Care Foundation, Hong Kong, Hong Kong (China)
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong (China)
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Trakulsunti Y, Antony J, Douglas JA. Lean Six Sigma implementation and sustainability roadmap for reducing medication errors in hospitals. TQM JOURNAL 2020. [DOI: 10.1108/tqm-03-2020-0063] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study is to propose a Lean Six Sigma (LSS) roadmap to guide healthcare practitioners in the implementation of LSS along with a customized LSS tool kit for reducing medication errors.Design/methodology/approachThe authors initially critically reviewed several frameworks/roadmaps of Lean, Six Sigma and LSS which have been proposed in healthcare sector from the existing literature. This review has led to an understanding of key characteristics, limitations and reasons behind the development of such frameworks/roadmaps. A conceptual roadmap was developed and then validated by a number of LSS experts and a healthcare practitioner. Based on the previous studies and taking LSS experts’ opinions into account, a revised roadmap for reducing medication is presented.FindingsThe roadmap for LSS in reducing medication errors is developed. This roadmap includes three phases: Phase 1 cultural readiness for LSS employment in reducing medication errors; Phase 2 preparation, initialization and implementation; and Phase 3 sustainability.Research limitations/implicationsThe roadmap has been tested with only a handful of practitioners of LSS. Moreover, only two case studies have been carried out in a Thai hospital setting which followed the roadmap. In order to improve the validity of research, more case studies need to be executed and more people should be used for testing the roadmap with varied cultures.Originality/valueThis is the first attempt in the development of a LSS roadmap that healthcare practitioners can follow to reduce medication errors using LSS methodology and sustaining LSS in their organizations.
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Odberg KR, Hansen BS, Aase K, Wangensteen S. A work system analysis of the medication administration process in a Norwegian nursing home ward. APPLIED ERGONOMICS 2020; 86:103100. [PMID: 32342890 DOI: 10.1016/j.apergo.2020.103100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/20/2020] [Accepted: 03/19/2020] [Indexed: 06/11/2023]
Abstract
Nursing home patients often have multiple diagnoses and a high prevalence of polypharmacy and are at risk of experiencing adverse drug events. The study aims to explore the dynamic interactions of stakeholders and work system elements in the medication administration process in a nursing home ward. Data were collected using observations and interviews. A deductive content analysis led to a SEIPS-based process map and an accompanying work system analysis. The study increases knowledge of the complexity of the medication administration process by portraying the dynamic interactions between the major stakeholders in the work system, and the temporal flow of the activities involved. Secondly, it identifies facilitators and barriers in the work system linked to the medication administration process. Most barriers and facilitators are associated with the work system elements - tools & technology, organisation and tasks - and occur early in the medication administration process.
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Affiliation(s)
- Kristian Ringsby Odberg
- Norwegian University of Science and Technology (NTNU), Department of Health Sciences in Gjøvik, Norway.
| | | | - Karina Aase
- University of Stavanger, Department of Health Studies, Centre Director, SHARE - Centre for Resilience in Healthcare, Norway
| | - Sigrid Wangensteen
- Norwegian University of Science and Technology (NTNU), Department of Health Sciences in Gjøvik, Norway.
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How smart medication systems are used to support older people's drug regimens: A systematic literature review. Geriatr Nurs 2020; 41:677-684. [PMID: 32192722 DOI: 10.1016/j.gerinurse.2020.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/17/2022]
Abstract
Smart medication systems are used to help older people, and the professionals and family who care for them, to organize and manage their daily drug regimes. However, synthetized knowledge on previous studies about how these improve everyday life is needed. We searched the PubMed, Scopus, CINAHL, PsycINFO, SocINDEX and Cochrane library databases from 2005 to 2019 and this review focused on nine of the 2,424 papers we identified. According to our analysis, smart medication systems make it possible to regulate medication times and doses and detect medication errors. With further development, smart medication systems could be more be effective at preventing medication errors, improving medication adherence by older people and freeing up healthcare professional, so that they can focus on other tasks. However, more research on different systems is needed to improve existing solutions and to understand how they can make older people more independent when it comes to their daily medication.
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Antony J, Forthun SC, Trakulsunti Y, Farrington T, McFarlane J, Brennan A, Dempsey M. An exploratory study into the use of Lean Six Sigma to reduce medication errors in the Norwegian public healthcare context. Leadersh Health Serv (Bradf Engl) 2019; 32:509-524. [PMID: 31612783 DOI: 10.1108/lhs-12-2018-0065] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Medication errors are a significant cause of injury in Norwegian hospitals. The purpose of this study is to explore how Lean Six Sigma (LSS) has been used in the Norwegian public health-care context to reduce medication errors. DESIGN/METHODOLOGY/APPROACH A mixed method approach was used to gather data from participants working in the four regions served by the Norway health authorities. A survey questionnaire was distributed to 38 health-care practitioners and semi-structured interviews were conducted with 12 health-care practitioners. FINDINGS The study finds that the implementation of LSS in the Norwegian public health-care context is still in its infancy. This is amidst several challenges faced by Norwegian hospitals such as the lack of top-management support, lack of LSS training and coaching and a lack of awareness around the benefits of LSS in health care. RESEARCH LIMITATIONS/IMPLICATIONS Because of the large geographical area, it was difficult to reach participants from all health regions in Norway. However, the study managed to assess the current status of LSS implementation through the participants' perspectives. This is a fruitful area for future research whereby an action research methodology could be used. ORIGINALITY/VALUE To the best of the authors' knowledge, this is the first empirical study into the use of LSS methodology in reducing medication errors. In addition, this study is valuable for health-care practitioners and professionals as a guideline to achieve the optimal benefit of LSS implementation to reduce medication errors.
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Affiliation(s)
- Jiju Antony
- Department of Business Management, Heriot-Watt University , Edinburgh, UK
| | | | - Yaifa Trakulsunti
- Department of Business Management, Heriot-Watt University , Edinburgh, UK
| | - Thomas Farrington
- Department of Business Management, Heriot-Watt University , Edinburgh, UK
| | - Julie McFarlane
- Hunter Centre for Entrepreneurship, University of Strathclyde , Glasgow, UK
| | - Attracta Brennan
- College of Engineering and Informatics, National University of Ireland Galway , Galway, UK
| | - Mary Dempsey
- College of Engineering and Informatics, National University of Ireland Galway , Galway, UK
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Hanratty B, Craig D, Brittain K, Spilsbury K, Vines J, Wilson P. Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BackgroundFlexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme.AimTo conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation.Objectives(1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes?Data sourcesSearches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search.DesignMapping review and rapid, systematic evidence syntheses.SettingCare homes with and without nursing in high-income countries.Review methodsPublished literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses.ResultsSeven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising.LimitationsThis review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded.ConclusionsThis review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation.Future workFuture work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context.Study registrationThis study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Barbara Hanratty
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Katie Brittain
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - John Vines
- Northumbria School of Design, Northumbria University, Newcastle upon Tyne, UK
| | - Paul Wilson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, University of Manchester, Manchester, UK
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Dubé PA, Portelance J, Corbeil O, Tessier M, St-Onge M. Drug Administration to the Wrong Nursing Home Residents Reported to the Québec Poison Center: A Retrospective Study. J Am Med Dir Assoc 2018; 19:891-895. [PMID: 29970296 DOI: 10.1016/j.jamda.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 04/23/2018] [Accepted: 05/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study examined the association between the administration of drugs to the wrong nursing home residents with a need for hospital treatment or as an indicator of mortality. DESIGN A retrospective observational study of medical records from February 1, 2016, to January 31, 2017. SETTING Calls made to the Quebec Poison Center. PARTICIPANTS Nursing home residents aged ≥65 years. INTERVENTION(S) Medication administered to the wrong resident. MAIN OUTCOME MEASURE(S) Death, hospital referral and treatment, number of drugs or type of drug classes. RESULTS Of the 6282 calls received by the Quebec Poison Center concerning medication errors, 494 cases were included in the retrospective study. Half of the patients (51%) received at least 5 different drugs that were not prescribed for them. Most patients (82%) were asymptomatic at the time of the call to the poison center; however, a third (34%) of the exposures were considered potentially toxic and were treated at the hospital. The most prominent drug classes involved include antihypertensives, antiarrhythmics, and antipsychotics. In particular, almost a quarter (23%) of cases of clozapine maladministration resulted in moderate or severe effects. No deaths were reported. CONCLUSIONS/IMPLICATIONS Medication errors in nursing homes are prevalent. The medical provider and probably the poison control center should be consulted as soon as possible when people are aware of administration of medication to the wrong patient, which is considered a medical emergency until proven otherwise. Public policies should seek for better surveillance and prompt intervention. Research should be undertaken to limit errors of drug administration to the wrong nursing home residents.
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Affiliation(s)
- Pierre-André Dubé
- Direction de la santé environnementale et de la toxicologie, Institut national de santé publique du Québec, Québec (Québec), Canada.
| | | | - Olivier Corbeil
- Faculté de pharmacie, Université Laval, Québec (Québec), Canada
| | - Mélanie Tessier
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec (Québec), Canada
| | - Maude St-Onge
- Centre antipoison du Québec, Québec (Québec), Canada
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Cready CM, Hudson C, Dreyer K. Type of oral solid medication packaging and medication preparation time in nursing homes: A direct observation study. J Clin Pharm Ther 2017; 42:710-719. [DOI: 10.1111/jcpt.12567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Affiliation(s)
- C. M. Cready
- Sociology; University of North Texas; Denton TX USA
| | - C. Hudson
- Sociology; University of North Texas; Denton TX USA
| | - K. Dreyer
- Public Administration; University of North Texas; Denton TX USA
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Arain M, Deutschlander S, Rostami M, Suter E. Should Health Care Aides Assist With Medications in Long-Term Care? Gerontol Geriatr Med 2016; 2:2333721416649130. [PMID: 28138498 PMCID: PMC5119863 DOI: 10.1177/2333721416649130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/17/2016] [Accepted: 04/18/2016] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective of the study was to determine whether health care aides (HCAs) could safely assist in medication administration in long-term care (LTC). Method: We obtained medication error reports from LTC facilities that involve HCAs in oral medication assistance and we analyzed Resident Assessment Instrument (RAI) data from these facilities. Standard ratings of error severity were "no apparent harm," "minimum harm," and "moderate harm." Results: We retrieved error reports from two LTC facilities with 220 errors reported by all health care providers including HCAs. HCAs were involved in 137 (63%) errors, licensed practical nurses (LPNs)/registered nurses (RNs) in 77 (35%), and pharmacy in four (2%). The analysis of error severity showed that HCAs were significantly less likely to cause errors of moderate severity than other nursing staff (2% vs. 7%, chi-square = 5.1, p value = .04). Conclusion: HCAs' assistance in oral medications in LTC facilities appears to be safe when provided under the medication assistance guidelines.
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Impact of Technological Innovation on a Nursing Home Performance and on the Medication-use Process Safety. J Med Syst 2014; 38:22. [DOI: 10.1007/s10916-014-0022-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
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