Designing an Intervention to Improve Medication Safety for Nursing Home Residents Based on Experiential Knowledge Related to Patient Safety Culture at the Nursing Home Front Line: Cocreative Process Study (Preprint)

Abstract

BACKGROUND Nursing homes constitute the home of frail people of older age, living with multiple chronic diseases and polypharmacy possibly related to medication errors and unsafe medication practices. Evidence on interventions to improve medication safety in nursing homes is scarce and inconclusive but earlier research indicate patient safety culture might hold a key. This study introduces an integrative approach to intervention development, navigating the complex terrain of patient safety through a co-creative process inspired by the Safety II Theory and Integrated Knowledge Translation (IKT). OBJECTIVE The overarching aim of this study was to develop an intervention to improve medication safety in nursing home residents in a co-creative process focused on frontline experiential knowledge on patient safety culture. METHODS The study employed a multistage co-creative process, incorporating exploratory focus groups and a multidisciplinary workshop. Research validation and contextualization were keys to result generation, to generate experiential knowledge and intervention components. An abductive approach to data analysis was undertaken Safety II Theory informed and IKT principles guided this study. RESULTS Exploration of patient safety culture was done in semi structured focus group interviews including social -and healthcare assistants and helpers besides from representatives of nursing home residents. Focus groups led to experiential knowledge represented by three main themes: 1) Closed subsystems and gaps between functions, 2) Resource interpretation and untapped potential, and 3) Community of medication safety and surveillance. Experiential knowledge informed the development of potential intervention components in a multidisciplinary workshop. Research validation and contextualization resulted in two potential intervention components developed 1) Campaign material visualizing key roles and responsibilities in medication in nursing home residents and 2) Creation of “Medication safety reflexive spaces”, covering the multifaceted design of the final intervention. CONCLUSIONS The purposively designed, co-creative process generated new experiential knowledge on patient safety culture based on nursing home frontline perceptions that informed the development of a new intervention. Through exploration of deep and vulnerable issues related to medication safety, represented by some of the most important but often underrepresented in research, the study generated results adding important new insights into the wicked challenge of medication safety in primary care. Our study brought attention to closed subsystems within medication management functions, revealing gaps between these functions. It underscored the untapped potential of experiential knowledge and emphasized the value of a sense of community as a resource. Additionally, we observed the emergence of surveillant communities in medication safety. These insights provide a valuable understanding of healthcare system dynamics and highlight opportunities for improvement. CLINICALTRIAL The trial is registered on ClinicalTrials.gov (NCT04990986) INTERNATIONAL REGISTERED REPORT RR2-10.2196/43538