A Tool to Ensure Appropriate Drug Use and Maintain Patient Safety When Administering Pro Re Nata Medications: Healthcare Providers’ Experiences With Medicine Lists in Sheltered Housing for Older People

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

Nurses are key professionals in ensuring safe drug management in nursing homes, and their practice is regulated by a number of guidelines. The present study aimed to explore nurses’ experiences of dispensing drugs to older people in nursing homes by using an exploratory qualitative design. Focus group interviews were conducted in three nursing homes in central Norway; the data were analyzed using qualitative content analysis. The results indicated that drug dispensing was perceived as a complicated process during which both anticipated and unforeseen challenges arose that influenced the nurses’ abilities to follow professional standards. In these situations, the nurses had to apply their knowledge and make various adjustments based on conditions in the organization and the needs of individual patients. The findings have implications for facilitating nurses’ working conditions and resources to avoid drug administration that limit the discretion of nurses and threaten patient safety in nursing homes.publishedVersio

Factors influencing prescribing of fall-risk-increasing drugs to the elderly : A qualitative study

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Manglende etterlevelse – også en bevisst handling

Alle pasienter har ulike oppfatninger av sykdom og legemidler. Pasienter veier gjerne nytten av legemiddelbehandlingen mot ulemp¬ene, og dette kommuniseres ikke alltid med helsepersonell. Tro på egen mestring av legemiddelregimet påvirker etterlevelse. Apotekpersonalet må ta hensyn til pasientenes oppfatninger om legemidler for å gi individuelt tilpasset informasjon og rådgivning, for dermed å sikre etterlevelse av legemiddelbehandlingen

Drug modification by nurses in Norwegian nursing homes : A cross-sectional study

Crushing and dividing pills among older patients in nursing homes appears to be a common yet not harmless practice. Because few updates exist regarding the role of nurses and their dispensing of drugs in nursing homes, this study sought to describe the occurrence, methods, and causes of nurses’ drug modification and to examine possible factors associated with drug modification in this context. A cross-sectional study of 273 dispensing episodes of solid oral drugs made by nurses, were observed during day and evening shifts. Modifications were made in 20.5% of the dispensing episodes, including 80.4% where alterations were made by crushing and 19.6% where alterations were made dividing. The most commonly reported reasons for modification were ‘swallowing difficulties’ (53.6%) and ‘lack of understanding by the patient’ (19.6%). The logistic regression analysis showed a significant association between the occurrence of drug modification and both cognitive impairment and administration method.publishedVersio

Factors influencing prescribing of fall-risk-increasing drugs to the elderly : A qualitative study

publishedVersio

Elderly users of fall-risk-increasing drug perceptions of fall risk and the relation to their drug use – a qualitative study

Objective: The aim of the study was to explore how home-dwelling elderly who use fall-risk-increasing drugs (FRIDs) perceive their fall risk and how they relate this to their drug use. Design, setting and subjects: A qualitative study with 14 home-dwelling elderly FRID users between 65 and 97 years in Central Norway participating in semi-structured individual interviews. The data were analyzed thematically by using systematic text condensation. Results: The main finding was that the informants did not necessarily perceive the use of FRIDs to be a prominent risk factor for falls. Some informants said they did not reflect upon drug use whatsoever and said they fully trusted their physician’s choices. When either experiencing dizziness, fall episodes or by reading the patient information leaflet the informants said to either adjust their drug use or to contact their physician. Some felt rejected due to not getting their point across or their wish to alter the drug was not granted by the physician. Conclusions: Elderly FRID users did not necessarily relate their drug use to fall risk or struggled to present their perceived drug-related problems. Physicians need to regularly inform, monitor and assess the drug treatment when treating elderly with FRIDs

Elderly users of fall-risk-increasing drug perceptions of fall risk and the relation to their drug use - a qualitative study

Objective: The aim of the study was to explore how home-dwelling elderly who use fall-riskincreasing drugs (FRIDs) perceive their fall risk and how they relate this to their drug use. Design, setting and subjects: A qualitative study with 14 home-dwelling elderly FRID users between 65 and 97 years in Central Norway participating in semi-structured individual interviews. The data were analyzed thematically by using systematic text condensation. Results: The main finding was that the informants did not necessarily perceive the use of FRIDs to be a prominent risk factor for falls. Some informants said they did not reflect upon drug use whatsoever and said they fully trusted their physician’s choices. When either experiencing dizziness, fall episodes or by reading the patient information leaflet the informants said to either adjust their drug use or to contact their physician. Some felt rejected due to not getting their point across or their wish to alter the drug was not granted by the physician. Conclusions: Elderly FRID users did not necessarily relate their drug use to fall risk or struggled to present their perceived drug-related problems. Physicians need to regularly inform, monitor and assess the drug treatment when treating elderly with FRIDs

Factors influencing prescribing of fall-risk-increasing drugs to the elderly: a qualitative study

Objective. Explore the situations in which GPs associate drug use with falls among their elderly patients, and the factors influencing the prescribing and cessation of fall-risk-increasing drugs (FRIDs). Design. A qualitative study with 13 GPs who participated in two semi-structured focus groups in Central Norway. Participants were encouraged to share overall thoughts on the use of FRIDs among elderly patients and stories related to prescribing and cessation of FRIDs in their own practice. Results. The main finding was that GPs did not immediately perceive the use of FRIDs to be a prominent factor regarding falls in elderly patients, exceptions being when the patient presented with dizziness, reported a fall, or when prescribing FRIDs for the first time. It was reported as common to renew prescriptions without performing a drug review. Factors influencing the prescribing and cessation of FRIDs were categorized into GPs’ clinical work conditions, uncertainty about outcome of changing prescriptions, patients’ prescribing demands, and lack of patient information. Conclusions. The results from this study indicate that GPs need to be reminded that there is a connection between FRID use and falls among elderly patients of enough clinical relevance to remember to assess the patient’s drug list and perform regular drug reviews

Drug modification by nurses in Norwegian nursing homes : A cross-sectional study

Crushing and dividing pills among older patients in nursing homes appears to be a common yet not harmless practice. Because few updates exist regarding the role of nurses and their dispensing of drugs in nursing homes, this study sought to describe the occurrence, methods, and causes of nurses’ drug modification and to examine possible factors associated with drug modification in this context. A cross-sectional study of 273 dispensing episodes of solid oral drugs made by nurses, were observed during day and evening shifts. Modifications were made in 20.5% of the dispensing episodes, including 80.4% where alterations were made by crushing and 19.6% where alterations were made dividing. The most commonly reported reasons for modification were ‘swallowing difficulties’ (53.6%) and ‘lack of understanding by the patient’ (19.6%). The logistic regression analysis showed a significant association between the occurrence of drug modification and both cognitive impairment and administration method