Medicines Management, Medication Errors and Adverse Medication Events in Older People Referred to a Community Nursing Service: A Retrospective Observational Study

Abstract

BackgroundIncreasing numbers of older people are receiving support with medicines management from community nursing services (CNSs) to enable them to live in their own homes. Little is known about these people and the support they receive.ObjectivesTo explore the characteristics of older people referred for medicines management support, type of support provided, medication errors and adverse medication events (AMEs).MethodsA retrospective observational study of a random sample of 100 older people referred to a large non-profit CNS for medicines management support over a 3-month period was conducted. Measures were: demographics, referral source, current medical problems, medicines, medication aids, types of medication authorisations used by nurses, frequency of nurse visits and type of support provided, medication errors, AMEs and interdisciplinary teamwork among community nurses, general practitioners and pharmacists.ResultsOlder people (median 80 years) were referred for medicines support most often by hospitals (39 %). Other referrals were from families/carers, case-managers, palliative care services and general practitioners. Multiple health conditions (median 5) and medicines (median 10) were common; 66 % used ≥5 medicines; 48 % used ≥1 high-risk medicines—most commonly opiates, anticoagulants and insulin. Medication aids were frequently used, mostly multi-compartment dose administration aids (47 %). Most people received regular community nurse visits (≥4 per week) to administer medicines or monitor medicine-taking. Only 16 % had a medication administration chart; for other clients nurses used medicine lists or letters from doctors for medication authorisation. Medication errors occurred in 41 % of people and 13 % had ≥1 AME requiring medical consultation or hospitalisation; 9/13 (64 %) AMEs were potentially preventable. There was little evidence of interdisciplinary teamwork or medication review.ConclusionCNS clients had multiple risk-factors for medication misadventure. Deficiencies in medicines management were identified, including low use of medication charts and interdisciplinary medication review. Strategies are needed to improve medicines management in the home-care setting.Electronic supplementary materialThe online version of this article (doi:10.1007/s40801-016-0065-6) contains supplementary material, which is available to authorized users.

Improving medication safety for home nursing clients: A prospective observational study of a novel clinical pharmacy service-The Visiting Pharmacist (ViP) study

“…Older people receiving medication management support from home nursing services have an average age over 80 years and often have multiple health conditions . They commonly take multiple medicines (average of 10), including medications associated with increased risk of AMEs .…”

“…Other common factors that predispose home nursing clients to increased risk of AMEs include recent hospital discharge, complex medication regimens, cognitive impairment and poor adherence to medicines . A recent Australian study identified that 41% of home nursing clients experienced medication errors and 13% experienced AMEs requiring hospitalization or medical consultation . Nearly two‐thirds of AMEs were potentially preventable, contributing to avoidable healthcare costs …”

“…A recent Australian study identified that 41% of home nursing clients experienced medication errors and 13% experienced AMEs requiring hospitalization or medical consultation . Nearly two‐thirds of AMEs were potentially preventable, contributing to avoidable healthcare costs …”

“…Although a Home Medicines Review (HMR) service is available in Australia, most home nursing clients do not receive this (HMR is a pharmacist‐conducted, interdisciplinary medication review funded by the Australian Government for people living in the community who are at risk of medication problems) . The uptake of HMR in this client group is around 5% . The HMR model, while useful, has several limitations and does not address the specific medication management needs of this complex group and the health professionals involved in their care, especially community nurses .…”

Chronic conditions and multimorbidity in a primary care population: a study in the Swiss Sentinel Surveillance Network (Sentinella)

“…Interestingly, institutionalized patients had a lower risk of being hospitalized as compared to people cared by their family or proxies, as well as by the community nurse (OR 6.8 and 8.5 vs. 4.3); this association also remained statistically significant in the adjusted analysis. People cared for by CNS are on risk for adverse drug reactions, medication errors, and hospitalization (Eliot et al 2016). Although care by CNS may prevent the need for stationary care (Markle-Reid et al 2006), there might still be an excessive need for it in CNS cared individuals compared to nursing home-dwelling persons.…”