Medication discrepancy rates and sources upon nursing home intake: A prospective study

Medication-related infrastructure and medication reviews in nursing homes-a rapid appraisal study

BACKGROUND

Around 86% of Switzerland's nursing home (NH) residents have polypharmacy (≥ 5 concomitant medications); almost 80% use a potentially inappropriate medication increasing their risk of medication-related problems. Medication reviews can optimize medication safety by fostering interprofessional collaboration, leading to medication therapy adjustments; they are currently being considered as a future national quality indicator of NH performance in Switzerland. The present study aimed to survey current medication-use infrastructure and processes and medication review practices in NHs in the German-speaking part of Switzerland. It also aimed to explore the barriers to, facilitators of, and prerequisites for medication review to become a national NH quality indicator.

METHODS

We took a rapid appraisal approach. Between February and August 2022, we distributed a structured online questionnaire to the participating NHs assessing the infrastructure and processes surrounding medication use, analyzing them quantitatively and descriptively. We followed up with 60-minute, in-depth, interprofessional, online group interviews, using a semi-structured interview guide, focusing on interprofessional collaboration and medication reviews. Data analysis was done iteratively in a descriptive manner.

RESULTS

Fourteen NHs in German-speaking regions of Switzerland completed the questionnaire, with 31 professionals from eleven of these NHs participating in group interviews. Almost half of the NHs (42.9%) had a cantonal license to run an in-house pharmacy, and in two-thirds of these, the legally responsible specialist was an external pharmacist. Community pharmacies supplied 92.9% of NHs with their medicines, mostly stored on the wards and prepared by nurses (57.1%). Accordingly, pharmacists were predominantly tasked with logistics, but were also key contacts for medication information. A clinical pharmacist participated in monthly ward rounds in just one NH. Medication verification occurred predominantly in the presence of physicians and sometimes nurses, mostly in the form of discussions during ward rounds or medication checks subsequent to an adverse event, rather than as part of comprehensive, proactive, interprofessional medication reviews. Interviewees identified numerous prerequisites before medication review could be used as a national NH quality indicator.

CONCLUSIONS

None of our participants contested the importance of medication safety and quality in NHs; they mostly favored regular medication reviews. However, interviewees expected that the nationwide introduction of medication reviews would require a standardized guide about its content, execution, analysis, and documentation, as well as interprofessional collaboration and some form of financial incentive. Promoting the use of medication reviews in NHs will have to involve interprofessional stakeholders in developing a specific implementation approach and defining the quality assessment requirements of an indicator. Further research into these topics would be highly relevant to ensure acceptance and success.

The art of making the right exception to the "rule": Nurses' experiences with drug dispensing in nursing homes

Nurses are key professionals in ensuring safe drug management in nursing homes, and their practice is regulated by a number of guidelines. The present study aimed to explore nurses' experiences of dispensing drugs to older people in nursing homes by using an exploratory qualitative design. Focus group interviews were conducted in three nursing homes in central Norway; the data were analyzed using qualitative content analysis. The results indicated that drug dispensing was perceived as a complicated process during which both anticipated and unforeseen challenges arose that influenced the nurses' abilities to follow professional standards. In these situations, the nurses had to apply their knowledge and make various adjustments based on conditions in the organization and the needs of individual patients. The findings have implications for facilitating nurses' working conditions and resources to avoid drug administration that limit the discretion of nurses and threaten patient safety in nursing homes.