Abstract The aim of the study was to determine nursing staff’s self-assessment of how they adhere to guidelines on safe medication administration during the medication process in long-term elderly care. In the first phase of this quantitative study, a Safe Medication Management Scale was developed and its reliability was evaluated. A panel of experts (n = 7) determined the scale’s content and the structure of its items. A pilot study was conducted with nursing staff from long-term elderly care wards in one town in northern Finland. The response rate was 24 % (n = 69). In the second phase, a cross-sectional study was conducted among nursing staff from long-term elderly care wards in one hospital district in Finland. The response rate was 39 % (n = 492). The majority of the nurses reported always adhering to guidelines during the medication process. However, one third of the nurses stated that they do not always follow guidelines when preparing medication, and approximately half stated that they do not always follow guidelines when administering medication. Shortcomings were identified in medication documentation, especially in the recording of the effects of medicine and the reason for administration. Routine checks were not always performed at different stages of the medication administration process. Also, patient involvement in the medication administration process was not always completed. Statistically significant associations were detected between the responses and the nurses’ self-assessment of how well they follow recommendations in general, as well as their knowledge of pharmacology and infection control, and their skill in performing medication calculations. A statistically significant association was detected in the age of the nurses; older age groups followed guidelines more thoroughly than younger age groups. When nurses self-assessed their activities in general at a higher level, they seemed to also follow guidelines better. Deviation from instructions and recommendations relating to the administration of medicines often leads to a medication error or creates an opportunity for errors to occur. The results of this study can be used to improve medication safety in long-term elderly care through the development of medication administration processes in organizations as well as the attitudes and competence of nursing staff so that medication is always given in accordance with instructions and recommendations. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata ja selittää lääkehoidon turvallista toteuttamista ikääntyneiden pitkäaikaishoidossa lääkehoitoon osallistuvan hoitohenkilöstön näkökulmasta. Tämän kvantitatiivisen poikkileikkaustutkimuksen ensimmäisessä vaiheessa kehitettiin lääkehoidon turvallisen toteuttamisen itsearviointimittari ja arvioitiin sen luotettavuutta. Mittarin sisällön validiuden arvioinnissa hyödynnettiin asiantuntijapaneelia (n = 7). Esitestaus tehtiin yhden kuusikkokunnan kunnallisissa ikääntyneiden pitkäaikaishoidon yksiköissä (n = 18). Vastausprosentti oli 24 % (n = 69). Toisen vaiheen perusjoukon muodostivat yhden sairaanhoitopiirin kunnallisten ikääntyneiden pitkäaikaishoidon yksiköiden lääkehoitoon osallistuvat hoitohenkilöstöt. Vastausprosentti oli 39 % (n = 492). Suurin osa hoitajista toteutti lääkehoitoa turvallisesti. Kuitenkin kolmannes hoitajista arvioi, että he eivät aina saata lääkkeitä käyttökuntoon ohjeiden ja suositusten mukaisesti. Lähes puolet arvioi poikkeavansa ohjeista ja suosituksista koskien lääkkeiden antamista ja lääkehoidon vaikutusten seurantaa ja arviointia. Kirjaamisessa havaittiin puutteita erityisesti lääkehoidon vaikutusten ja lääkkeen antamisen syiden kirjaamisessa. Rutiininomaisia tarkistuksia ei aina tehty lääkehoidon prosessin vaiheissa. Potilaan osallistaminen lääkehoidon prosessiin ei arviointien mukaan myöskään aina toteutunut. Mitä paremmin hoitaja koki hallitsevansa farmakologian, infektioiden torjunnan ja lääkelaskennan, sitä paremmin hän myös näytti toteuttavan lääkehoitoa. Hoitajan iällä havaittiin tilastollisesti merkitsevä yhteys lähes kaikkien osa-alueiden kanssa; iältään vanhemmat toteuttivat lääkehoitoa huolellisemmin suosituksia ja ohjeistuksia noudattaen kuin nuoremmat. Mitä paremmaksi hoitajat itsearvioivat toimintansa yleisesti, sitä paremmin he näyttivät vastausten perusteella toteuttavan lääkehoitoa. Kun lääkehoidon ohjeista ja suosituksista poiketaan, aiheuttaa se usein lääkityspoikkeaman tai sen mahdollisuuden. Poikkeama voi aiheuttaa myös lääkehaittatapahtuman. Tässä tutkimuksessa tuotetun tiedon avulla ikääntyneiden pitkäaikaishoidon lääkitysturvallisuutta voidaan parantaa kehittämällä sekä yksikön lääkehoidon toteuttamisen prosesseja, että hoitohenkilöstön lääkehoidon asenteita ja osaamista sellaisiksi, että lääkehoitoa toteutetaan kaikissa tilanteissa ohjeistusten ja suositusten mukaisesti.

Secondary infusions are a common and convenient method to administer intermittent infusions unattended through a single IV access using infusion pump technology. Previous studies have indicated that clinicians have a high frequency of committing operation errors while administering secondary infusions, which can cause patient harm. The purpose of this study was to evaluate the safety of secondary infusion practice by identifying and analyzing potential failure modes when delivering secondary infusions on five different smart infusion pumps. Healthcare Failure Mode and Effect Analysis (HFMEA) was used to prioritize potential failure modes that are considered high-risk for each pump. Results showed that four of the five pumps were not able to mitigate physical set-up errors. As well, each pump contributed differently to programming errors due to difference in interface design. Recommendations from this study focused on outlining desired infusion pump features and mitigation strategies to help alleviate high-risk secondary infusion failure modes.

Secondary infusions are a common and convenient method to administer intermittent infusions unattended through a single IV access using infusion pump technology. Previous studies have indicated that clinicians have a high frequency of committing operation errors while administering secondary infusions, which can cause patient harm. The purpose of this study was to evaluate the safety of secondary infusion practice by identifying and analyzing potential failure modes when delivering secondary infusions on five different smart infusion pumps. Healthcare Failure Mode and Effect Analysis (HFMEA) was used to prioritize potential failure modes that are considered high-risk for each pump. Results showed that four of the five pumps were not able to mitigate physical set-up errors. As well, each pump contributed differently to programming errors due to difference in interface design. Recommendations from this study focused on outlining desired infusion pump features and mitigation strategies to help alleviate high-risk secondary infusion failure modes.

Master of Pharmacy / Medicines are a fundamental healthcare intervention, but the benefits they provide depend entirely on the way in which they are used. This begins with prescribing, a complex task with substantial risks. Systematic evaluation of biomedical factors may be viewed as an essential component of this task, but prescribers also integrate an array of individual, social, cultural, environmental and commercial factors into their prescribing decisions. Furthermore, social and cultural characteristics of the prescriber’s workplace may influence how well prescribing decisions are carried out. Whilst numerous research efforts have helped to construct an in-depth understanding of non-biomedical influences on GP’s prescribing patterns, the characteristics of corresponding sorts of influences in teaching hospitals have not been well determined. In hospitals, supervised medical trainees, registrars and consultants prescribe within the framework of medicines management systems involving nurses, pharmacists and patients. Currently, little is known about whether each of these groups has distinct beliefs, attitudes and values that may affect either prescribing behaviour or how prescribing skills of medical trainees are acquired. The aim of this study was to explore the social and cultural dynamics of prescribing and prescriber training in teaching hospitals. To do this, established qualitative methods were employed. Junior doctors, registrars, consultants, nurses, and pharmacists from two metropolitan teaching hospitals were sampled purposively and invited to participate in semi-structured interviews. A brief questionnaire was used to collect demographic and contextual information. In the interviews, participants were asked about their attitudes towards prescribing, their perceptions of roles and responsibilities, how they communicated prescribing decisions, their perceptions of influences on prescribing, and their perceptions of factors contributing to prescribing errors. Participants were also asked for their opinions on various aspects of new prescriber training. Sampling proceeded until redundancy of themes was established. A pilot study was conducted with one participant from each professional group to optimise the interview schedule, and then using this tool, a further 38 participants were interviewed. In total, eight consultants, eight registrars, nine junior doctors, eleven pharmacists, and seven nurses participated. Using reiterative content analysis of a third of all transcripts, a coding scheme was developed, which was used to label and categorise the remaining transcripts. Categories were further developed and refined. The resultant core themes were cross indexed against the five different health professional types using thematic charts to explore patterns. The main lines of enquiry for this research were mapped, the properties of these categories and interrelationships explored in detail, and a model of the prescribing process was developed. Prescribing at the teaching hospitals was a complex process consisting of multiple steps undertaken by several different health professionals of varying levels of experience from three different health care disciplines. Because of the intricate separation of responsibilities, the operation of the process was highly reliant on the behaviours of each player and their relationships with each other. Key prescribing decisions associated with patient admissions were made, almost exclusively, by medical teams. Prescribing was therefore chiefly characterised by factors influencing the behaviours of the doctors. Their behaviours were influenced by factors relating to their individual characteristics (eg, knowledge, skills, experience); but also by a web of socio-cultural determinants inherent to the environment in which they worked. These factors were related to: the organisational structure of the prescribing process; the knowledge characteristics of the doctors; the communication patterns they used; the underlying assumptions they made about prescribing; and the work environment.

Master of Pharmacy / Medicines are a fundamental healthcare intervention, but the benefits they provide depend entirely on the way in which they are used. This begins with prescribing, a complex task with substantial risks. Systematic evaluation of biomedical factors may be viewed as an essential component of this task, but prescribers also integrate an array of individual, social, cultural, environmental and commercial factors into their prescribing decisions. Furthermore, social and cultural characteristics of the prescriber’s workplace may influence how well prescribing decisions are carried out. Whilst numerous research efforts have helped to construct an in-depth understanding of non-biomedical influences on GP’s prescribing patterns, the characteristics of corresponding sorts of influences in teaching hospitals have not been well determined. In hospitals, supervised medical trainees, registrars and consultants prescribe within the framework of medicines management systems involving nurses, pharmacists and patients. Currently, little is known about whether each of these groups has distinct beliefs, attitudes and values that may affect either prescribing behaviour or how prescribing skills of medical trainees are acquired. The aim of this study was to explore the social and cultural dynamics of prescribing and prescriber training in teaching hospitals. To do this, established qualitative methods were employed. Junior doctors, registrars, consultants, nurses, and pharmacists from two metropolitan teaching hospitals were sampled purposively and invited to participate in semi-structured interviews. A brief questionnaire was used to collect demographic and contextual information. In the interviews, participants were asked about their attitudes towards prescribing, their perceptions of roles and responsibilities, how they communicated prescribing decisions, their perceptions of influences on prescribing, and their perceptions of factors contributing to prescribing errors. Participants were also asked for their opinions on various aspects of new prescriber training. Sampling proceeded until redundancy of themes was established. A pilot study was conducted with one participant from each professional group to optimise the interview schedule, and then using this tool, a further 38 participants were interviewed. In total, eight consultants, eight registrars, nine junior doctors, eleven pharmacists, and seven nurses participated. Using reiterative content analysis of a third of all transcripts, a coding scheme was developed, which was used to label and categorise the remaining transcripts. Categories were further developed and refined. The resultant core themes were cross indexed against the five different health professional types using thematic charts to explore patterns. The main lines of enquiry for this research were mapped, the properties of these categories and interrelationships explored in detail, and a model of the prescribing process was developed. Prescribing at the teaching hospitals was a complex process consisting of multiple steps undertaken by several different health professionals of varying levels of experience from three different health care disciplines. Because of the intricate separation of responsibilities, the operation of the process was highly reliant on the behaviours of each player and their relationships with each other. Key prescribing decisions associated with patient admissions were made, almost exclusively, by medical teams. Prescribing was therefore chiefly characterised by factors influencing the behaviours of the doctors. Their behaviours were influenced by factors relating to their individual characteristics (eg, knowledge, skills, experience); but also by a web of socio-cultural determinants inherent to the environment in which they worked. These factors were related to: the organisational structure of the prescribing process; the knowledge characteristics of the doctors; the communication patterns they used; the underlying assumptions they made about prescribing; and the work environment.

No description available.

Abstract According to the law patients have a right to good care and the care has to be of a high level, safe and evidence based. Medication has been found to be a nursing procedure that is associated with many risks. It has been documented that mistakes occur even in every fifth medication event. All Finnish nurses have been trained to carry out advanced medication and iv-therapy, and it is the nurses who are the main administrators of medication in the health care units. For these reasons nurses' medication competence is important. The constant development of medical treatment increases the demands of nurses' competence in medication. The aim of the study was to describe and to explain the medication competence of nurses assessed by themselves and according to theoretical and online exams. The aim was to describe the nurses' perceptions of the verification process of medication competence and e-learning as the method for verification. The quantitative data of the study consisted of 692 nurses´ self-assessment of medication competence and of 2479 nurses' results on theoretical and drug calculation exams. The qualitative data consisted of 342 nurses' perceptions of the verification and e-learning. In the theoretical exam the nurses had 84,9% correct answers while the required level to pass was 75%. The nurses themselves considered their medication competence to be good. Challenges were found most in the areas of anatomy, physiology and pharmacology, and in reading of professional and scholarly literature. About 5% of the nurses had persistent problems in the drug calculations. Diluting and solution calculations were the most challenging ones. The nurses who had taken the online course considered their medication competence better than the other nurses. The ones who regularly administer advanced medication and iv-therapy in their daily work considered their medication competence better than the other nurses. The nurses accepted the verification process of medication competence, and e-learning was considered a sound teaching method. Some of the nurses criticised the present model of verification and they wished for verification that is better targeted to their daily duties. In addition to e-learning they wished for other teaching methods. A nationally and even internationally standardised model needs to be developed for verification of nurses’ medication competence. / Tiivistelmä Potilailla on lain mukaan oikeus hyvään hoitoon, ja hoidon tulee olla korkeatasoista, turvallista ja näyttöön perustuvaa. Lääkehoito on todettu riskialttiiksi tehtäväksi. Jopa joka viidennessä lääkitystapahtumassa on havaittu tapahtuvan virheitä. Kaikki suomalaiset sairaanhoitajat ovat saaneet koulutuksen vaativan neste- ja lääkehoidon toteuttamiseen, ja sairaanhoitajat ovatkin terveydenhuollon toimintayksiköissä keskeisiä lääkehoidon toteuttajia. Näistä syistä sairaanhoitajien lääkehoidon osaaminen on tärkeää. Lääkehoidon jatkuva kehittyminen lisää sairaanhoitajien osaamisen vaatimuksia. Tämän tutkimuksen tarkoituksena oli kuvata ja selittää sairaanhoitajien lääkehoidon osaamista heidän itsensä arvioimana ja lääkehoidon teoria- ja lääkelaskutentin perusteella. Tutkimuksen tarkoituksena oli myös kuvata sairaanhoitajien käsityksiä lääkehoidon osaamisen varmistamisesta ja verkko-oppimisesta osaamisen varmistamisen menetelmänä. Tutkimuksen määrällinen aineisto koostui 692 sairaanhoitajan lääkehoidon osaamisen itsearvioinnista ja 2 479 sairaanhoitajan teoria- ja lääkelaskutentin tuloksista. Laadullinen aineisto perustui 342 sairaanhoitajan käsityksiin lääkehoidon osaamisen varmistamisesta ja verkko-oppimisesta. Teoriatentissä sairaanhoitajat saivat 84,9 % kysymyksistä oikein, kun hyväksyttyyn suoritukseen vaadittiin 75 % oikein. Sairaanhoitajat arvioivat lääkehoidon osaamisensa hyväksi. Anatomian, fysiologian ja farmakologian tiedoissa sekä ammatillisen ja tieteellisen tiedon lukemisessa oli eniten haasteita. Lääkelaskuissa toistuvia ongelmia oli n. 5 %:lla vastaajista. Haastavimpia olivat infuusioihin ja laimennoksiin liittyvät laskut. Lääkehoidon verkkokurssin käyneet arvioivat osaamisensa paremmaksi kuin muut vastaajat. Säännöllisesti työssään vaativaa neste- ja lääkehoitoa toteuttavat arvioivat lääkehoidon osaamisensa muita paremmiksi. Sairaanhoitajat hyväksyivät lääkehoidon osaamisen varmistamisen prosessin, ja verkkokurssi oli heidän käsitystensä mukaan toimiva opetusmenetelmä. Osa sairaanhoitajista kritisoi nykyistä osaamisen varmistamisen mallia ja he toivoivat enemmän työtehtäviin kohdennettua osaamisen varmistamista. Verkko-oppimisen rinnalle toivottiin muita opetusmenetelmiä. Lääkehoidon osaamisen varmistamisesta tulisi jatkossa kehittää kansallisesti yhtenäinen ja jopa kansainvälinen malli.

Medication administration errors (MAEs) may lead to adverse drug events, patient morbidity, prolonged hospital stays, and increased readmission rates, and may contribute to major financial losses for the health system. MAEs are the most common type of error occurring within the health care setting leading to an estimated 7,000 patient deaths every year. Interventions have been designed to prevent MAEs including education for nurses who administer medications; however, little effort has been made to design systematic educational programs that are based on local needs and contexts. The purpose of this project was to identify internal and external factors related to MAEs at the practice site, develop an education program tailored to the factors contributing to MAEs, and implement the program using a pretest posttest design. The Iowa model was used to guide the project. The 26 nurse participants who responded to an initial survey indicated that nurses felt distractions and interruptions during medication administration, and hesitancy to ask for help or to report medication errors increased MAE risks. After the education program, the pretest and posttest results were analyzed and revealed improvement in knowledge and confidence of medication administration (M = 3.2 pre, M = 3.7 post, p < .05). Open-ended question responses suggested a need for dedicated time for preparation and administration of medications without interruptions. Positive social change is possible as nurses become knowledgeable and confident about medication administration safety and as patients are protected from injury secondary to MAEs.

No description available.

Yes / Multiple changes are made to older patients' medicines during hospital admission, which can sometimes cause confusion and anxiety. This results in problems with post-discharge medicines management, for example medicines taken incorrectly, which can lead to harm, hospital readmission and reduced quality of life. To explore the experiences of older patients and their family carers as they enacted post-discharge medicines management. Semi-structured interviews took place in participants' homes, approximately two weeks after hospital discharge. Data analysis used the Framework method. Recruitment took place during admission to one of two large teaching hospitals in North England. Twenty-seven participants aged 75 plus who lived with long-term conditions and polypharmacy, and nine family carers, were interviewed. Three core themes emerged: impact of the transition, safety strategies and medicines management role. Conversations between participants and health-care professionals about medicines changes often lacked detail, which disrupted some participants' knowledge and medicines management capabilities. Participants used multiple strategies to support post-discharge medicines management, such as creating administration checklists, seeking advice or supporting primary care through prompts to ensure medicines were supplied on time. The level to which they engaged with these activities varied. Participants experienced gaps in their post-discharge medicines management, which they had to bridge through implementing their own strategies or by enlisting support from others. Areas for improvement were identified, mainly through better communication about medicines changes and wider involvement of patients and family carers in their medicines-related care during the hospital-to-home transition. / This work was supported by the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC). This independent research is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0317-20010).