Factors affecting Australian aged care facility workers in administering oral medication to residents with swallowing difficulties

Abstract

Swallowing difficulties are common in older people and can complicate the administration of oral medications. The aim of this study was to explore factors affecting healthcare workers in their practices of oral medication administration to aged care residents with swallowing difficulties. A purposeful sample of 17 healthcare workers comprised of clinical/care managers, registered nurses (RNs), enrolled nurses (ENs), and assistants in nursing (AINs) from three aged care facilities in Queensland, Australia participated in semi-structured interviews. Leximancer was used for quantitative content analysis. The responses centered on three main factors. Participants discussed work process-related factors including time, workload, and stress and frustrations resulting from work processes. Medication-related factors included 2 strategies to facilitate medication administration, uncertainties around modifying medications, availability/cost of alternatives, multidisciplinary medication management, prescribing considerations, and polypharmacy. Resident-related factors were discussed around individualized needs of residents especially those with dementia-associated swallowing difficulties. Ideas differed among the four groups of participants. Managers discussed work process-related factors pertaining to staff and facility. RNs focused on how clinical aspects of the medication practices were affected by work processes. ENs were task-oriented and their responses focused on work-processes. AIN responses centered on reliance on RNs in performing medication tasks. The findings suggest that healthcare workers' practices of medication administration to residents with swallowing difficulties are affected by various factors associated with work processes, medications, and resident characteristics. Although these factors affect all levels of healthcare workers, the needs of each group vary depending on their level of training and responsibilities.

Factors that affect health‐care workers’ practices of medication administration to aged care residents with swallowing difficulties: An Australia‐wide survey study

“…The reason could be the concerns around competing demands of families or liability issues imposed to health‐care workers if medications are given incorrectly due to family influence on the process of medication administration 12,24 . While the findings of this study did not support the direct involvement of families in the process of medication administration, there should be opportunities for family involvement in the creation of the care plan or during the speech pathologist or nurse assessment of swallowing 14 …”

“…The questionnaire consisted of 26 closed (eg multiple‐choice and Likert format) and open‐ended questions in three sections consisting of 1) demographics, 2) current practices of medication administration to residents and 3) barriers and facilitators. The questions were derived based on the themes identified in a previous interview study that investigated the opinions of health‐care workers in ACFs regarding factors that affect medication administration to residents with swallowing difficulties 14 . To test the content validity of the included questions, the survey was initially administered to a group of health‐care professionals including three pharmacists, two nurses, one speech pathologist and two nursing students.…”

“…These issues are compounded by the limitations associated with the cost and availability of resources to train and support health‐care workers to administer medications to residents with swallowing difficulties 12,13 . There are also mixed views around the role of families in managing residents with swallowing difficulties, such as family support during mealtimes or conflicting demands in selecting appropriate medications for residents, for example, due to cost considerations 12,14 . A qualitative systematic review on nurse experiences of oral medication administration to aged care residents with swallowing difficulties identified scarce evidence, with only one study conducted among 11 nurses in ten Australian ACFs 15 .…”

Optimization of solid oral dosage form administration to patients with swallowing difficulties: An integrative review

“…According to the severity of swallowing difficulties and the risk of aspiration, the speech therapist determines adequate liquid thickness and food texture (Barnett & Parmar, 2016), which, if necessary, can be achieved with the addition of thickeners (Cichero, 2013; Wright et al., 2020). The thickeners are often added to liquids and food to enhance swallowing (Barnett & Parmar, 2016; Health and Social Northern Ireland, 2018; Hernández‐Martín et al., 2013; Sefidani‐Forough et al., 2020b). However, despite the relevant advantage of reducing the risk of aspiration (Schiele et al., 2015), the thickeners have the potential to delay or even avoid the disintegration of SODF and or drug dissolution, especially considerable amounts (Cichero, 2013; Manrique et al., 2014; Matsuo, Sato, Kudo, et al., 2020; Matsuo, Sato, Tomita, & Sadzuka, 2020).…”

“…According to the severity of swallowing difficulties and the risk of aspiration, the speech therapist determines adequate liquid thickness and food texture (Barnett & Parmar, 2016), which, if necessary, can be achieved with the addition of thickeners (Cichero, 2013;Wright et al, 2020). The thickeners are often added to liquids and food to enhance swallowing (Barnett & Parmar, 2016;Health and Social Northern Ireland, 2018;Hernández-Martín et al, 2013;Sefidani-Forough et al, 2020b).…”