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Caspi E, Xue WL, Liu PJ. Theft of Controlled Substances in Long-Term Care Homes: An Exploratory Study. J Appl Gerontol 2023:7334648231153731. [PMID: 36691366 DOI: 10.1177/07334648231153731] [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: 01/25/2023] Open
Abstract
The theft of controlled substances has been studied in the community and healthcare settings including hospitals, pharmacies, hospice, and pain clinics. However, research on these thefts in long-term care homes has yet to be published. This exploratory study makes first steps toward bridging this gap. Using 107 Minnesota Department of Health's investigation reports substantiated as "drug diversion" between 2013 and 2021 in assisted living residences and nursing homes, we found that 11,328.5 tablets were stolen from 368 residents (97.5% were controlled substances), with over 30 tablets stolen per resident. We also identified the types of medications stolen, duration of theft, extent to which nurses stole the medications or were those initially suspecting thefts, and the role of surveillance cameras in confirming allegations. The findings could raise awareness to this form of elder mistreatment in long-term care homes and call for action to address it.
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Affiliation(s)
| | - Wei-Lin Xue
- School of Nursing and Center on Aging and the Life Course, 311308Purdue University, West Lafayette, IN, USA
| | - Pi-Ju Liu
- School of Nursing and Center on Aging and the Life Course, 311308Purdue University, West Lafayette, IN, USA
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Poh L, Tan SY, Lim J. Governance of Assisted Living in Long-Term Care: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11352. [PMID: 34769868 PMCID: PMC8583175 DOI: 10.3390/ijerph182111352] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
Assisted living (AL) is an emerging model of care in countries where long-term care needs are escalating, with emphasis given to promoting independence and autonomy among the residents to achieve active and healthy ageing. Unlike established nursing homes, the governance of AL is nebulous due to its novelty and diverse nature of operations in many jurisdictions. A comprehensive understanding of how AL is governed globally is important to inform regulatory policies as the adoption of AL increases. A systematic literature review was undertaken to understand the different levels of regulations that need to be instituted to govern AL effectively. A total of 65 studies, conducted between 1990 to 2020, identified from three major databases (PubMed, Medline, and Scopus), were included. Using a thematic synthesis analytical approach, we identified macro-level regulations (operational authorisation, care quality assessment and infrastructural requirements), meso-level regulations (operational management, staff management and distribution, service provision and care monitoring, and crisis management), and micro-level regulations (clear criteria for resident admission and staff hiring) that are important in the governance of AL. Large-scale adoption of AL without compromising the quality, equity and affordability would require clear provisions of micro-, meso- and macro-level regulations.
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Affiliation(s)
- Luting Poh
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr., Singapore 119260, Singapore;
| | - Si-Ying Tan
- Leadership Institute for Global Health Transformation, Saw Swee Hock School of Public Health, National University of Singapore, 21 Lower Kent Ridge Rd., Singapore 119260, Singapore
| | - Jeremy Lim
- Leadership Institute for Global Health Transformation, Saw Swee Hock School of Public Health, National University of Singapore, 21 Lower Kent Ridge Rd., Singapore 119260, Singapore
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Errors linked to medication management in nursing homes: an interview study. BMC Nurs 2021; 20:69. [PMID: 33926436 PMCID: PMC8082477 DOI: 10.1186/s12912-021-00587-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/14/2021] [Indexed: 11/20/2022] Open
Abstract
Background The number of errors in medication management in nursing homes is increasing, which may lead to potentially life-threatening harm. Few studies on this subject are found in the municipal nursing home setting, and causes need to be identified. The aim of this study was to explore perceptions of errors connected to medication management in nursing homes by exploring the perspective of first-line registered nurses, registered nurses, and non-licensed staff involved in the care of older persons. Methods A qualitative research approach was applied based on semi-structured interviews with 21 participants at their workplaces: Seven in each of the occupational categories of first-line registered nurses, registered nurses, and non-licensed staff. Subcategories were derived from transcribed interviews by content analysis and categorized according to the Man, Technology, and Organization concept of error causation, which is as a framework to identify errors. Results Mistakes in medication management were commonly perceived as a result of human shortcomings and deficiencies in working conditions such as the lack of safe tools to facilitate and secure medication management. The delegation of drug administration to non-licensed staff, the abandonment of routines, carelessness, a lack of knowledge, inadequate verbal communication between colleagues, and a lack of understanding of the difficulties involved in handling the drugs were all considered as risk areas for errors. Organizational hazards were related to the ability to control the delegation, the standard of education, and safety awareness among staff members. Safety issues relating to technology involved devices for handling prescription cards and when staff were not included in the development process of new technological aids. A lack of staff and the lack of time to act safely in the care of the elderly were also perceived as safety hazards, particularly with the non-licensed staff working in nursing homes. Conclusions The staff working in nursing homes perceive that the risks due to medication management are mainly caused by human limitations or technical deficiencies. Organizational factors, such as working conditions, can often facilitate the occurrence of malpractice. To minimize mistakes, care managers need to have a systemwide perspective on safety issues, where organizational issues are essential.
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Han K, Trinkoff AM, Storr CL, Lerner N, Yang BK. Variation Across U.S. Assisted Living Facilities: Admissions, Resident Care Needs, and Staffing. J Nurs Scholarsh 2016; 49:24-32. [PMID: 27860170 DOI: 10.1111/jnu.12262] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Though more people in the United States currently reside in assisted living facilities (ALFs) than nursing homes, little is known about ALF admission policies, resident care needs, and staffing characteristics. We therefore conducted this study using a nationwide sample of ALFs to examine these factors, along with comparison of ALFs by size. DESIGN Cross-sectional secondary data analysis using data from the 2010 National Survey of Residential Care Facilities. METHODS Measures included nine admission policy items, seven items on the proportion of residents with selected conditions or care needs, and six items on staffing characteristics (e.g., access to licensed nurse, aide training). Facilities (n = 2,301) were divided into three categories by size: small, 4 to 10 beds; medium, 11 to 25 beds; and large, 26 or more beds. Analyses took complex sampling design effects into account to project national U.S. estimates. FINDINGS More than half of ALFs admitted residents with considerable healthcare needs and served populations that required nursing care, such as for transfers, medications, and eating or dressing. Staffing was largely composed of patient care aides, and fewer than half of ALFs had licensed care provider (registered nurse, licensed practical nurse) hours. Smaller facilities tended to have more inclusive admission policies and residents with more complex care needs (more mobility, eating and medication assistance required, short-term memory issues, p < .01) and less access to licensed nurses than larger ALFs (p < .01). CONCLUSIONS This study suggests ALFs are caring for and admitting residents with considerable care needs, indicating potential overlap with nursing home populations. Despite this finding, ALF regulations lag far behind those in effect for nursing homes. In addition, measurement of care outcomes is critically needed to ensure appropriate ALF care quality. CLINICAL RELEVANCE As more people choose ALFs, outcome measures for ALFs, which are now unavailable, should be developed to allow for oversight and monitoring of care quality.
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Affiliation(s)
- Kihye Han
- Lambda Alpha-at-Large, Assistant Professor, Chung-Ang University Red Cross College of Nursing, Seoul, South Korea
| | - Alison M Trinkoff
- Pi, Professor, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Carla L Storr
- Professor, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Nancy Lerner
- Pi, Assistant Professor, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Bo Kyum Yang
- Pi, Doctoral Candidate, University of Maryland School of Nursing, Baltimore, MD, 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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Levy CR, Alemi F, Williams AE, Williams AR, Wojtusiak J, Sutton B, Giang P, Pracht E, Argyros L. Shared Homes as an Alternative to Nursing Home Care: Impact of VA's Medical Foster Home Program on Hospitalization. THE GERONTOLOGIST 2015; 56:62-71. [PMID: 26384495 DOI: 10.1093/geront/gnv092] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/27/2015] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY This study compares hospitalization rates for common conditions in the Veteran Affairs (VA) Medical Foster Home (MFH) program to VA nursing homes, known as Community Living Centers (CLCs). DESIGN AND METHODS We used a nested, matched, case control design. We examined 817 MFH residents and matched each to 3 CLC residents selected from a pool of 325,031. CLC and MFH cases were matched on (a) baseline time period, (b) follow-up time period, (c) age, (d) gender, (e) race, (f) risk of mortality calculated from comorbidities, and (g) history of hospitalization for the selected condition during the baseline period. Odds ratio (OR) and related confidence interval (CI) were calculated to contrast MFH cases and matched CLC controls. RESULTS Compared with matched CLC cases, MFH residents were less likely to be hospitalized for adverse care events, (OR = 0.13, 95% CI = 0.03-0.53), anxiety disorders (OR = 0.52, 95% CI = 0.33-0.80), mood disorders (OR = 0.57, 95% CI = 0.42-0.79), skin infections (OR = 0.22, 95% CI = 0.10-0.51), pressure ulcers (OR = 0.22, 95% CI = 0.09-0.50) and bacterial infections other than tuberculosis or septicemia (OR = 0.54, 95% CI = 0.31-0.92). MFH cases and matched CLC controls did not differ in rates of urinary tract infections, pneumonia, septicemia, suicide/self-injury, falls, other injury besides falls, history of injury, delirium/dementia/cognitive impairments, or adverse drug events. Hospitalization rates were not higher for any conditions studied in the MFH cohort compared with the CLC cohort. IMPLICATIONS MFH participants had the same or lower rates of hospitalizations for conditions examined compared with CLC controls suggesting that noninstitutional care by a nonfamilial caregiver does not increase hospitalization rates for common medical conditions.
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Affiliation(s)
- Cari R Levy
- Department of Internal Medicine, Palliative Care, Veterans Affairs Medical Center Eastern Colorado Health Care System, Denver
| | - Farrokh Alemi
- Department of Health Administration and Policy, George Mason University, Fairfax Virginia. Office of Chief of Staff, District of Columbia Veterans Affairs Medical Center, Washington DC.
| | | | - Arthur R Williams
- Center of Innovation on Disability and Rehabilitation Research, James A Haley Veterans Administration Medical Center, Tampa, Florida
| | - Janusz Wojtusiak
- Department of Health Administration and Policy, George Mason University, Fairfax Virginia
| | - Bryce Sutton
- Center of Innovation on Disability and Rehabilitation Research, James A Haley Veterans Administration Medical Center, Tampa, Florida
| | - Phan Giang
- Department of Health Administration and Policy, George Mason University, Fairfax Virginia
| | - Etienne Pracht
- Department of Health Administration and Policy, University of South Florida, Tampa
| | - Lisa Argyros
- Bay Pines Veterans Administration Healthcare System, Florida
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Fitzgibbon M, Lorenz R, Lach H. Medication reconciliation: reducing risk for medication misadventure during transition from hospital to assisted living. J Gerontol Nurs 2013; 39:22-9; quiz 30-1. [PMID: 24102104 DOI: 10.3928/00989134-20130930-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 04/23/2013] [Indexed: 11/20/2022]
Abstract
The discharge of older adults from hospital to home has been associated with poor outcomes. It is well documented that performing medication reconciliation at every transition point is critical to ensuring patient safety, preventing unnecessary rehospitalizations, and reducing the risk for medication misadventures. However, the medication reconciliation process is not well executed in numerous institutions and possibly not at all in many assisted living facilities (ALFs). Thus, the purpose of this study was to examine medication discrepancies that occur as a result of transitioning from hospitals to ALFs and to explore the role of nurses regarding medication reconciliation in ALFs. A comparison of medication records for 80 residents ages 65 and older revealed that 86.2% of resident records had at least one medication discrepancy. These results represent an opportunity for nurses to be involved with post-acute care communication and medication reconciliation to improve safe transitions for residents in ALFs.
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Simonson W, Novak R, Jennewine T. Requirements for medication monitoring in assisted living facilities. ACTA ACUST UNITED AC 2013; 28:569-78. [PMID: 24007889 DOI: 10.4140/tcp.n.2013.569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine requirements for medication monitoring in assisted living in the United States. DATA SOURCES Comprehensive list maintained by the National Center for Assisted Living reporting individual state entities that are responsible for oversight of assisted living facilities. Reviews of respective entity Web sites were performed July to September 2011. STUDY SELECTION Web sites of all 50 states reporting statutes and regulations pertaining to assisted living and medication review. DATA EXTRACTION Appropriate state Web sites were reviewed to determine state-specific definitions, statutes, and regulations pertaining to requirements for medication review in assisted living and persons or entities responsible for this review. Telephone interviews were conducted with appropriate individuals when questions existed or clarifications were needed. DATA SYNTHESIS Forty states recognize or define the living environment of assisted living, and 10 describe it using other terms. Thirty states have specific requirements for medication review in assisted living facilities, which vary greatly by required frequency, health care discipline responsible for conducting medication monitoring, and non-time-dependent criteria that trigger the review. CONCLUSION Considerable diversity exists among states in requirements for medication review in the assisted living environment. The requirements in some states resemble national nursing facility standards of practice for pharmacy services, while others have few or no requirements for medication review. Regulations do not always require a pharmacist to perform this review.
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Harrison MB, Keeping-Burke L, Godfrey CM, Ross-White A, McVeety J, Donaldson V, Blais R, Doran DM. Safety in home care: a mapping review of the international literature. INT J EVID-BASED HEA 2013. [DOI: 10.1111/1744-1609.12027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Polypharmacy is generally defined as the use of 5 or more prescription medications on a regular basis. The average number of prescribed and over-the-counter medications used by community-dwelling older adults per day in the United States is 6 medications, and the number used by institutionalized older persons is 9 medications. Almost all medications affect nutriture, either directly or indirectly, and nutriture affects drug disposition and effect. This review will highlight the issues surrounding polypharmacy, food-drug interactions, and the consequences of these interactions for the older adult.
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Affiliation(s)
- Roschelle Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt Pleasant, Michigan 48859, USA.
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Ziminski CE, Phillips LR. The Nursing Role in Reporting Elder Abuse: Specific Examples and Interventions. J Gerontol Nurs 2011; 37:19-23. [DOI: 10.3928/00989134-20111010-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Charboneau AL, Shelton PS, Brickley JB, Rich W. Medication errors and penalties in assisted living facilities. ACTA ACUST UNITED AC 2011; 26:554-65. [PMID: 21840819 DOI: 10.4140/tcp.n.2011.554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the percentage of medication-related proposed penalties for licensed assisted living facilities in North Carolina. DESIGN This retrospective, cross-sectional study examined all proposed penalties and related case-file narratives stemming from annual surveys of licensed assisted living facilities conducted by the state between July 2007 and December 2008. The percentage of medication-related deficiencies and proposed penalties were calculated. Associations between the medication-related proposed penalties and facility size, location, and penalty type were explored using chi-square tests. SETTING Assisted living facilities in North Carolina. MAIN OUTCOME MEASURES Percentage of medication- and non-medication-related penalties. RESULTS A total of 1,256 licensed assisted living facilities (51% adult care homes, 59% metropolitan) were surveyed during the study period. There were 88 proposed penalties (51% medication-related) among 60 facilities. No association between medication-related proposed penalties and facility size or location was detected. However, an association (P = 0.002) was found between type of penalty (A or B) and whether the proposed penalty was medication- or non-medication-related (37.3% and 70.3% of Type A and B penalties, respectively, were medication related). Medications commonly cited were insulin, cardiovascular agents, supplements, anticonvulsants, and antipsychotics. Common categories of medication errors were drug not administered and wrong dose administered. CONCLUSIONS Medication errors, regardless of facility size or location, were contributing factors in approximately one-half of violations sufficient enough to warrant a penalty proposal among the licensed assisted living facilities in North Carolina. These findings demonstrate a need for continued regulation and increased pharmacist involvement to improve medication safety.
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