Background: Residents living in sheltered housing depend on help from healthcare personnel (HCP) with medication management, regarding regular long-term and pro re nata (PRN) medication. The HCP assess the need for PRN medication prior to administration to the residents. The purpose of this study was to describe HCP's perceptions of factors affecting PRN medication management in sheltered housing for older adults. Method: This was a qualitative study with five focus-group interviews with 22 HCP working in sheltered housing for older adults. The HCP were heterogenous regarding scholarly education and experiences, working in four different municipalities in mid-Norway, representing urban, suburban and rural districts. The analysis was inductive, based on qualitative, manifest, content analysis. The main outcome was HCP perceptions of the factors affecting PRN medication management in sheltered housing. Results: Four main factors affecting the PRN medication management were identified in the data and were related to either: 1) the medication; 2) the resident; 3) the HCP; or 4) the organisation. These categories included 14 subcategories. Overall, the HCP described the management of PRN medication as a complex process, where the above factors all have impact on the residents' health and safety. Conclusion: HCP working in sheltered housing describe that PRN medication management is affected by numerous human factors, that consequently may affect patient outcomes and safety. HCP involved in PRN medication management should be aware of factors that affect their decision-making, and safe management requires a professional practice built on medicines competence, practical skills and experience.

Vitenskapelig publikasjon'Sometimes we just have to trust our gut feeling and hope the reporting is good'.Healthcare providers' experiences of pro re nata medication decision-making in sheltered housing

Residents living in sheltered housing may need assistance with the administration of medications, including medications used as needed. Healthcare providers can then administer medications based on the resident’s medication list. The aim of this study is to expand our understanding of how healthcare providers utilize medication lists in managing pro re nata medications. Based on a secondary analysis of qualitative data, we found that medication lists are important tools to ensure appropriate medication use, and to maintain patient safety in sheltered housing. The results show that the interviewees expected updated and unambiguous medication lists in order to safeguard uniform practice, and maintain confidence in the administration of pro re nata medications. However, they often experienced ambiguous medication lists, putting a strain on quality of care. To manage updated medication lists and provide safe administration of pro re nata medications, the interviewees asked for closer collaboration with general practitioners, in which case medication reviews could be a solution.

Vitenskapelig publikasjon Kan organisering av omsorgsboliger for eldre påvirke praksis i forbindelse med legemidler som gis ved behov? En fokusgruppeintervju-studie Can the organization of care homes for the elderly influence practices regarding medicines that are given as needed? A focus group interview study

Although pro re nata medications (PRNM) are widely used among older patients in long-term care, current knowledge about nurses’ PRNM management is scarce. The study aim was to describe which knowledge sources nurses working in sheltered housing for older people use when making decisions regarding PRNM. This was a qualitative interview study with registered nurses ( n = 4) and assistant nurses ( n = 4) working in sheltered housings in mid and eastern Norway. Data analysis was based on qualitative and abductive content analysis, where evidence-based practice (EBP) was used in the abduction. The COREQ checklist was followed. Several knowledge sources are used when making decisions regarding PRNM, that represent the four elements of EBP. ‘Practitioner experience and judgement’ was a prominent source of knowledge among the nurses, while ‘Evaluated external evidence’ was less emphasized in PRNM decision-making. The results support previous research on EBP in nursing, and bring new knowledge regarding PRNM in the context of sheltered housing. To achieve appropriate and safe management of PRNM, there is a need to support nurses’ decision-making process, e.g. through PRNM guidelines and systems for documentation and information exchange. EBP in PRNM decision processes should be given attention, utilizing all elements including ‘Evaluated external evidence’ as a knowledge source.