Medication administration and interruptions in nursing homes: A qualitative observational study

Odberg, Kristian Ringsby; Hansen, Britt Sætre; Aase, Karina; Wangensteen, Sigrid

doi:10.1111/jocn.14138

Cited by 21 publications

(34 citation statements)

References 48 publications

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“…Medication administration in nursing homes is a complex process taking place in a complex system with inherent vulnerabilities, placing high demands on the sociotechnical work system and the staff (Carayon et al, ; Choo et al, ; Grigg et al, ; Odberg et al, ). Findings in the current study document this complexity and elaborate on how the staff and particularly the RN’s adjust to shifting circumstances in their work environment.…”

Section: Discussionmentioning

confidence: 99%

“…At the same time, the staff were obliged to undertake a variety of tasks, not all of them clinically related. These findings seem universal as RN's often are required to undertake multiple tasks simultaneously in stress-inducing physical environments, making them more prone to making errors (Carayon et al, 2014;Monroe & Graham, 2005;Odberg et al, 2017). Under high workload, administrative tasks related to medication administration took precedence for the RN's, thus delegating the remaining workload to the other staff members.…”

Section: The Nurses Are Compensatingmentioning

confidence: 99%

“…It is generally acknowledged that adverse events related to medication administration account for a significant threat to overall patient safety (Kohn, Corrigan, & Donaldson, ; Makeham, Dovey, Runciman, & Larizgoitia, ; Marchon & Mendes, ; Vogelsmeier, ). Medication administration involves an intricate mixture of various tasks and demands that temporally structure the nurse’s workday (Carayon et al, ; Grigg, Garrett, & Craig, ; Jennings, Sandelowski, & Mark, ; Moyen, Camiré, & Stelfox, ; Odberg, Sætre Hansen, Aase, & Wangensteen, ).…”

Section: Introductionmentioning

confidence: 99%

“…The medication administration process consists of six stages: ordering and prescription; transcribing; dispensing; preparing; administering; and finally observing and documenting effects and side effects (Carayon et al, ). Medication administration errors (MAE) may occur anywhere along this chain and cause an adverse drug event (ADE; Carayon et al, ; Choo, Hutchinson, & Bucknall, ; Odberg et al, ; Smeulers, Onderwater, Zwieten, & Vermeulen, ). According to WHO (), MAE’s are preventable at different levels.…”

Section: Introductionmentioning

confidence: 99%

“…Many factors influence safe medication management. Some argue that nurses (RN) may have insufficient knowledge and skills to perform safe medication management (Andersson, Frank, Willman, Sandman, & Hansebo, ; Simonsen, ); others point to normalization of risk‐inducing behaviour and interruptions (Odberg et al, ), or use of technology, design flaws, time constraints, poor communication, lack of leadership, as well as outdated policies and guidelines (Al‐Jumaili & Doucette, ; Carayon et al, ; Keers, Williams, Cooke, & Ashcroft, ; Lapkin, Levett‐Jones, Chenoweth, & Johnson, ; Marasinghe, ). There is an apparent lack of studies investigating the nurse role during medication administration in nursing homes.…”

Section: Introductionmentioning

confidence: 99%

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Medication administration in nursing homes: A qualitative study of the nurse role

2018

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Aims The objective of this study was to expand the knowledge of the nurse role during medication administration in the context of nursing homes. The following research question guided the study: How can the nurse role during medication administration in nursing homes be described? Design A QUAL–qual mixed study design was applied. Methods Data were collected using partial participant observations and semi‐structured interviews of all staff members involved in medication administration. An inductive content analysis was performed. Results Medication administration is a pervasive process ingrained in the day‐to‐day activities of providing care to the patients. The nurse role is compensating, flexible and adaptable. There is a dynamic interaction between several contributory factors, those being shifting responsibility, a need for competence, invisible leadership, varying available competence, staff stability and vulnerable shifts.

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Section: Discussionmentioning

confidence: 99%

Section: The Nurses Are Compensatingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Medication administration in nursing homes: A qualitative study of the nurse role

2018

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Interventions to optimize medication use in nursing homes: a narrative review

2021

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Purpose Polypharmacy, medication errors and adverse drug events are frequent among nursing home residents. Errors can occur at any step of the medication use process. We aimed to review interventions aiming at optimization of any step of medication use in nursing homes. Methods We narratively reviewed quantitative as well as qualitative studies, observational and experimental studies that described interventions, their effects as well as barriers and enablers to implementation. We prioritized recent studies with relevant findings for the European setting. Results Many interventions led to improvements in medication use. However, because of outcome heterogeneity, comparison between interventions was difficult. Prescribing was the most studied aspect of medication use. At the micro-level, medication review, multidisciplinary work, and more recently, patient-centered care components dominated. At the macro-level, guidelines and legislation, mainly for specific medication classes (e.g., antipsychotics) were employed. Utilization of technology also helped improve medication administration. Several barriers and enablers were reported, at individual, organizational, and system levels. Conclusion Overall, existing interventions are effective in optimizing medication use. However there is a need for further European well-designed and large-scale evaluations of under-researched intervention components (e.g., health information technology, patient-centered approaches), specific medication classes (e.g., antithrombotic agents), and interventions targeting medication use aspects other than prescribing (e.g., monitoring). Further development and uptake of core outcome sets is required. Finally, qualitative studies on barriers and enablers for intervention implementation would enable theory-driven intervention design.

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

et al. 2022

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Medication administration and interruptions in nursing homes: A qualitative observational study

Abstract: Staff and management need to be aware of the normalisation of interruptions. Knowledge of the complexity of medication administration may raise awareness and highlight the importance of maintaining and enhancing staff competence.

Cited by 21 publications

References 48 publications

Medication administration in nursing homes: A qualitative study of the nurse role

Medication administration in nursing homes: A qualitative study of the nurse role

Interventions to optimize medication use in nursing homes: a narrative review

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

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