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

Solberg, Hege; Devik, Siri Andreassen; Bell, Hege Therese; Olsen, Rose Mari

doi:10.1016/j.gerinurse.2022.02.019

Cited by 10 publications

(5 citation statements)

References 36 publications

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“…On the other hand, they are also mindful of the need to maintain correctness and compliance with regulations. This also supports findings from our previous study (Solberg et al., 2022) that drug dispensing involves challenges that require RNs to use their discretion and make various adaptations to ensure medication safety. Drug dispensing is not a simple technical procedure that can be carried out based on rigid standards and guidelines.…”

Section: Discussionsupporting

confidence: 90%

“…Context may also explain why setting priorities was often used by the RNs in our study. As reported in one of our previous studies (Solberg et al., 2022), drug dispensing in nursing homes is a complicated process that involves many priorities. Not only must the RNs prioritise the dispensing of certain drugs due to time constraints, but they also have to prioritise so that the dispensing suits each patient and their circadian rhythm.…”

Section: Discussionmentioning

confidence: 85%

“…Moreover, RNs working in nursing homes often contend with heavy workloads, characterised by numerous tasks, interruptions and the care of patients with significant disease burdens, all within the constraints of limited personnel and expertise (Odberg et al., 2018). During drug dispensing, RNs confront unforeseen challenges that demand their knowledge and discretion to navigate successfully (Solberg et al., 2022).…”

Section: Introductionmentioning

confidence: 99%

“…During drug dispensing, RNs confront unforeseen challenges that demand their knowledge and discretion to navigate successfully (Solberg et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

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Thinking strategies used by registered nurses during drug administration in nursing homes—An observational study

Solberg,

Devik,

Bell

et al. 2023

Journal of Clinical Nursing

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AimTo explore registered nurses' thinking strategies during the drug administration process in nursing homes.DesignAn exploratory qualitative design.MethodsEight registered nurses, one male and seven female, in five nursing home wards in Mid‐Norway were observed during 15 drug dispensing rounds (175 drug dispensing episodes). Think Aloud sessions with follow‐up individual interviews were conducted. The Think Aloud data were analysed using deductive qualitative content analysis based on Marsha Fonteyn's description of 17 thinking strategies. Interview data were used to clarify missing information and validate the content of Think Aloud data.ResultsThe registered nurses used all 17 thinking strategies described by Fonteyn, including several variants of each strategy. The three most frequent were ‘providing explanations’, ‘setting priorities’ and ‘drawing conclusions’. In addition, we found two novel thinking strategies that did not fit into Fonteyn's template, which were labelled ‘controlling’ and ‘interacting’. Among all strategies, ‘controlling’ was by far the most used, serving as a means for the registered nurses to stay on track and navigate through various interruptions, while also minimising errors during drug dispensing.ConclusionThe study highlights the diverse thinking strategies employed by registered nurses in nursing homes during medication administration. The findings emphasise the multifaceted nature of medication administration and underscore the importance of skilled personnel in ensuring medication safety. Recognising the significance of these findings is crucial for maintaining patient well‐being and upholding medication safety standards in healthcare settings.Relevance to Clinical PracticeUnderstanding the thinking strategies employed by registered nurses can inform training programmes and enhance the clinical judgements of health care professionals involved in medication administration, ultimately leading to improved patient outcomes and reduced medication errors in practice.Patient or Public ContributionPatients were involved in this study as recipients of drugs which the nurses distributed during the observations. The patients were involved as a third party and consent to the observations was either given by the patients themselves or relatives in cases where the patient was not competent to consent. No personal information was collected about the patients.Reporting MethodThe reporting of this study adhered to the COREQ checklist.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

“…During drug dispensing, RNs confront unforeseen challenges that demand their knowledge and discretion to navigate successfully (Solberg et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Thinking strategies used by registered nurses during drug administration in nursing homes—An observational study

Solberg,

Devik,

Bell

et al. 2023

Journal of Clinical Nursing

Self Cite

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“…However, they did not reflect on this practice in terms of the possibility that the resident's health may have changed since last time, or the risk of drug-drug or drug-disease interaction. Another study, from Norwegian nursing homes, also found that deviation from guidelines in medication management was a conscious choice, adjusting the practice to fit the circumstances (Solberg et al, 2022).…”

Section: Collaboration With the General Practitionermentioning

confidence: 99%

Medication Safety in Municipal Health and Care Services

2022

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Medication administration in aged care facilities: A mixed‐methods systematic review

Garratt,

Dowling,

Manias

2024

Journal of Advanced Nursing

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Aim(s)To synthesize aged care provider, resident and residents' family members' perspectives and experiences of medication administration in aged care facilities; to determine the incidence of medication administration errors, and the impact of medication administration on quality of care and resident‐centredness in aged care facilities.DesignA mixed‐methods systematic review. PROSPERO ID: CRD42023426990.Data SourcesThe AMED, CINAHL, MEDLINE, EMBASE, EMCARE, PsycINFO, Scopus and Web of Science core collection databases were searched in June 2023.Review MethodsIncluded studies were independently screened, selected and appraised by two researchers. The Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) checklist was followed, with the Mixed Methods Appraisal Tool was used for critical appraisal. Convergent synthesis of data, thematic synthesis and meta‐analysis were performed.ResultsOne hundred and twenty‐eight studies were included (33 qualitative, 85 quantitative and 10 mixed‐methods). Five themes were formulated, including 1) Staffing concerns, 2) The uncertain role of residents, 3) Medication‐related decision‐making, 4) Use of electronic medication administration records and 5) Medication administration errors. Educational interventions for aged care workers significantly reduced medication administration errors, examined across five studies (OR = 0.37, 95%CI 0.28–0.50, p < .001).ConclusionsMedication administration in aged care facilities is challenging and complex on clinical and interpersonal levels. Clinical processes, medication errors and safety remain focal points for practice. However, more active consideration of residents' autonomy and input by aged care workers and providers is needed to address medication administration's interpersonal and psychosocial aspects. New directions for future research should examine the decision‐making behind dose form modification, aged care workers' definitions of medication omission and practical methods to support residents' and their family members' engagement during medication administration.Implications for the profession and/or patient careIt is important that medication administration in aged care facilities be more clearly acknowledged as both a clinical and interpersonal task. More attention is warranted regarding aged care workers clinical decision‐making, particularly concerning dose form modification, covert administration and medication omissions. Resident‐centred care approaches that support resident and family engagement around medication administration may improve adherence, satisfaction and quality of care.ImpactWhat Problem Did the Study Address? Medication administration in aged care facilities is a complex clinical and interpersonal activity. Still, to date, no attempts have been made to synthesize qualitative and quantitative evidence around this practice. There is a need to establish what evidence exists around the perspectives and experiences of aged care workers, residents and resident's family members to understand the challenges, interpersonal opportunities and risks during medication administration.What Were the Main Findings? There is a lack of empirical evidence around resident‐centred care approaches to medication administration, and how residents and their families could be enabled to have more input. Dose form modification occurred overtly and covertly as part of medication administration, not just as a method for older adults with swallowing difficulties, but to enforce adherence with prescribed medications. Medication administration errors typically included medication omission as a category of error, despite some omissions stemming from a clear rationale for medication omission and resident input.Where and on Whom Will the Research Have an Impact?The findings of this systematic review contribute to aged care policy and practice regarding medication administration and engagement with older adults. This review presents findings that provide a starting point for aged care workers in regards to professional development and reflection on practice, particularly around clinical decision‐making on dose form modification, medication administration errors and the tension on enabling resident input into medication administration. For researchers, this review highlights the need to develop resident‐centred care approaches and interventions, and to assess whether these can positively impact medication administration, resident engagement, adherence with prescribed medications and quality of care.Reporting MethodThis systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (Page et al., 2021).Patient or Public ContributionNo patient or public contribution to this systematic review.

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

Cited by 10 publications

References 36 publications

Thinking strategies used by registered nurses during drug administration in nursing homes—An observational study

Thinking strategies used by registered nurses during drug administration in nursing homes—An observational study

Medication Safety in Municipal Health and Care Services

Medication administration in aged care facilities: A mixed‐methods systematic review

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