Legemiddelinteraksjoner hos pasienter i sykehjem

Søraas, Ingvild Aune; Staurset, Hanne Baust; Slørdal, Lars; Spigset, Olav

doi:10.4045/tidsskr.13.1550

Cited by 21 publications

(10 citation statements)

References 23 publications

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“…The lower prevalence of DRPs as compared to other Norwegian studies reporting 2.5–3.5 DRPs/patient [ 1 , 12 , 13 ], might be related to more staffing with full-time rather than part-time physicians in Oslo and an increased focus in recent years on safer prescribing practice for the elderly. The average number of drug used per patient before the MR compares well or is slightly lower than in other studies reporting 6.1–9.8 regular [ 1 , 4 , 5 , 13 , 16 , 20 , 24 , 25 ] and 2.8–3.8 prn drugs [ 4 , 20 ]. The high drug utilization at NHs may also partly reflect that the drug regiments are based on guidelines developed for younger patients with less comorbidity and the lack of consensus on best practice for pharmacotherapy in the oldest old.…”

Section: Discussionsupporting

confidence: 72%

“…However, we consider the validity of the results to be reasonable high because 82% of all NHs included 61% of all long-term care patients in the municipality, and because terminal illness was the only exclusion criterion. Furthermore, the patients’ age and sex distribution correspond well with that of the total NH population in the city and country [ 4 , 12 , 13 , 20–22 ]. Similar MR procedures at the various sites were ensured through training of the MR teams, standardized tools and classification systems [ 8–11 ] and because each pharmacist participated in several hundred MRs.…”

Section: Discussionmentioning

confidence: 90%

“…A typical NH patient is an old (mean age, 86 years) and frail female with short life expectancy [ 3 ]. Because of multiple comorbidities, they use around eight drugs on a regular basis [ 1 , 4 , 5 ] and have thus an increased risk of drug–drug interactions [ 4 ] and adverse drug reactions [ 6 ]. Frailty, cognitive impairment [ 3 ] and age-related changes in pharmacokinetics and pharmacodynamics add further to these risks [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Drug-related problems and changes in drug utilization after medication reviews in nursing homes in Oslo, Norway

Fog

Kvalvaag²,

Engedal

et al. 2017

Scandinavian Journal of Primary Health Care

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ObjectiveWe describe the drug-related problems (DRPs) identified during medication reviews (MRs) and the changes in drug utilization after MRs at nursing homes in Oslo, Norway. We explored predictors for the observed changes.DesignObservational before-after study.SettingForty-one nursing homes.InterventionMRs performed by multidisciplinary teams during November 2011 to February 2014.SubjectsIn all, 2465 long-term care patients.Main outcome measuresDRPs identified by explicit criteria (STOPP/START and NORGEP) and drug–drug interaction database; interventions to resolve DRPs; drug use changes after MR.ResultsA total of 6158 DRPs were identified, an average of 2.6 DRPs/patient, 2.0 for regular and 0.6 for pro re nata (prn) drugs. Of these patients, 17.3% had no DRPs. The remaining 82.7% of the patients had on average 3.0 DRPs/patient. Use of unnecessary drugs (43.5%), excess dosing (12.5%) and lack of monitoring of the drug use (11%) were the most frequent DRPs. Opioids and psychotropic drugs were involved in 34.4% of all DRPs. The mean number of drugs decreased after the MR from 6.8 to 6.3 for regular drugs and from 3.0 to 2.6 for prn drugs. Patients with DRPs experienced a decrease of 1.1 drugs after MR (0.5 for regular and 0.6 for prn drugs). The reduction was most pronounced for the regular use of antipsychotics, antidepressants, hypnotics/sedatives, diuretics, antithrombotic agents, antacid drugs; and for prn use of anxiolytics, opioids, hypnotics/sedatives, metoclopramide and NSAIDs.ConclusionThe medication review resulted in less drug use, especially opioids and psychotropic drugs.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Drug-related problems and changes in drug utilization after medication reviews in nursing homes in Oslo, Norway

Fog

Kvalvaag²,

Engedal

et al. 2017

Scandinavian Journal of Primary Health Care

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“…There is also an increased risk of fall injuries and errors due to multiple medication and potential drug interactions [14, 15]. Studies by Soraas et al (2014) and Gulla et al (2016) found that the use of eight or more drugs is frequent in Norwegian nursing homes, leading to increased risk of drug-drug interactions, which in turn may lead to falls, cognitive decline, medication-related problems, and even increased mortality [16–20]. In nursing homes, physicians frequently prescribe drugs without a proper clinical evaluation of the patient, and staff may not be aware of this [21].…”

Section: Introductionmentioning

confidence: 99%

Patient safety culture in Norwegian nursing homes

Bondevik

Hofoss

Husebø

et al. 2017

BMC Health Serv Res

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BackgroundPatient safety culture concerns leader and staff interaction, attitudes, routines, awareness and practices that impinge on the risk of patient-adverse events. Due to their complex multiple diseases, nursing home patients are at particularly high risk of adverse events. Studies have found an association between patient safety culture and the risk of adverse events. This study aimed to investigate safety attitudes among healthcare providers in Norwegian nursing homes, using the Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV). We studied whether variations in safety attitudes were related to professional background, age, work experience and mother tongue.MethodsIn February 2016, 463 healthcare providers working in five nursing homes in Tønsberg, Norway, were invited to answer the SAQ-AV, translated and adapted to the Norwegian nursing home setting. Previous validation of the Norwegian SAQ-AV for nursing homes identified five patient safety factors: teamwork climate, safety climate, job satisfaction, working conditions and stress recognition. SPSS v.22 was used for statistical analysis, which included estimations of mean values, standard deviations and multiple linear regressions. P-values <0.05 were considered to be significant.ResultsOut of the 463 employees invited, 288 (62.2%) answered the questionnaire. Response rates varied between 56.9% and 72.2% across the five nursing homes. In multiple linear regression analysis, we found that increasing age and job position among the healthcare providers were associated with significantly increased mean scores for the patient safety factors teamwork climate, safety climate, job satisfaction and working conditions. Not being a Norwegian native speaker was associated with a significantly higher mean score for job satisfaction and a significantly lower mean score for stress recognition. Neither professional background nor work experience were significantly associated with mean scores for any patient safety factor.ConclusionsPatient safety factor scores in nursing homes were poorer than previously found in Norwegian general practices, but similar to findings in out-of-hours primary care clinics. Patient safety culture assessment may help nursing home leaders to initiate targeted quality improvement interventions. Further research should investigate associations between patient safety culture and the occurrence of adverse events in nursing homes.

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“…The majority of residents are women occupying more than 70% of the nursing home beds [12]. The nursing home patients in the area of the study used 9,8 drugs on average with a variation of 0 to 30 different drugs [13]. Part-time contracted general practitioners most commonly provide the medical services in nursing homes [14], however, number of full time nursing home physicians employed by the muncicpality is raising.…”

Section: Settingmentioning

confidence: 99%

Next of Kin, An Invisible Resource In The Drug Treatment of Nursing Home Residents: A Qualitative Study

Bell¹,

Vaage²

2022

Preprint

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Objective: Explore next of kin’s perceptions of the ongoing drug treatment given to nursing home residents, and their perceptions of the collaboration with health personnel at the nursing home. Design, setting and subjects: A qualitative study with ten next of kin to nursing home residents who participated in semi-structured individual interviews in Central and Southern Norway. The data were analysed thematically by using systematic text condensation.Results: Next of kin express a trust towards the drug treatment given, however, the trust is fragile. There was an urge for information and of being in control, not necessarily with the aim to influence treatment but to know what happens to their loved ones. Due to long-lasting knowledge of the resident, they viewed themselves as the resident’s advocate to ensure appropriate drug treatment. The collaboration between health personnel and next-of-kin were scarce and described as an “us-them” relationship. Next of kin perceived having to force an entry for dialogue and of health personnel being inaccessible and invisible.Conclusion: Next of kin want to be informed about the ongoing drug treatment given to the resident, however, information given are scarce and delayed which affect the trust towards health personnel at the nursing home. Input from next of kin could be used to offer person-centered care, however, next of kin perceive their input often being ignored. Implications: Effort must be put to unite expectations and seek a mutual understanding of which role next of kin should hold regarding information and collaboration about the ongoing drug treatment of the nursing home resident.

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Legemiddelinteraksjoner hos pasienter i sykehjem

Cited by 21 publications

References 23 publications

Drug-related problems and changes in drug utilization after medication reviews in nursing homes in Oslo, Norway

Drug-related problems and changes in drug utilization after medication reviews in nursing homes in Oslo, Norway

Patient safety culture in Norwegian nursing homes

Next of Kin, An Invisible Resource In The Drug Treatment of Nursing Home Residents: A Qualitative Study

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