Enhancing Patient Safety in Nursing Homes
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Enhancing Patient Safety in Nursing Homes
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Contextual Overview of Patient Safety Priorities in Nursing Home Care
All healthcare professionals know that their patients' safety is the top priority and something they may maintain. According to Wondmieneh et al. (2020), providing medication without creating any misunderstanding that could endanger the patient's health is one of the most important ways to maintain even the highest caliber of nursing care. That renders it imperative to address any potential obstacle impeding their ability to deliver high-quality results. Nevertheless, research indicates that even with efforts to support individuals, medication errors continue to be a significant risk to patients in nursing homes since potentially inappropriate medication (PIM) has become prevalent in these homes (Koçak et al., 2022). The assessment explores a risk to patient safety related to medication reconciliation and presents a thorough quality improvement plan to reduce that risk. The assessment focuses on defining the causes (contributing factors) of medication errors, investigating evidence-based treatments, explaining the critical function of nurses in care coordination, and determining the key stakeholders involved in advancing safety improvements.
Analysis of Contributing Factors Leading to Medication Errors in Nursing Facilities
Medication errors stem from straightforward but interrelated issues that must be thoroughly examined to resolve. According to Wondmieneh et al. (2020), inadequate medication reconciliation procedures are one of the leading causes of medication errors. A crucial component of patient care is the pharmacologic review, which entails carefully reviewing a patient's prescription schedule to find and fix any inconsistencies. Despite its apparent simplicity, it significantly impacts ensuring accurate and secure drug administration. Errors are more likely to happen in nursing homes with inadequate reconciliation processes, which could negatively impact patient outcomes. Medication errors about pro re nata (PRN) prescriptions may be linked to PIM (Koçak et al., 2022). Also, prolonged stays in nursing homes (NHs) are associated with higher rates of PIM use and PRN prescriptions. Consequently, when deciding which prescription drugs are unsuitable for NHs, PRN medications should be taken into account. The risk of PIMs rises with multiple prescriptions among patients in nursing homes (Nadeau et al., 2021). A subtle source of PIM that affects compliance with treatment for chronic illnesses, particularly cardiovascular disease, HIV infection, and kidney failure, is pill burden or the number of pills taken daily.
Additionally, it has always been challenging to manage medication in older people, leading to medication errors, especially in nursing homes. A contributing factor to the problem is that approximately 50% of people residing in nursing homes have Alzheimer's disease or other dementias (Bates & Zebrowski, 2022). Consequently, they cannot frequently independently manage their medications and may exhibit complex behavioral problems. Residents can struggle with self-advocacy regardless of whether they experience cognitive impairment. However, because clinical staffing models differ significantly amongst facilities, clients in nursing homes may see clinicians less often or regularly have multiple comorbidities and an increased risk of medication side effects. In addition, choosing and administering medications to clients in nursing homes involves a lot of trade-offs, which may lead to medication errors (Bates & Zebrowski, 2022). Growing older is linked to a decline in physiological reserve overall and a higher vulnerability to drug side effects that affect cognition specifically.
Evaluation of Evidence-Based Interventions to Reduce Medication Errors
While enhancing patient safety, medical facilities can implement evidence-based strategies to address the ongoing issue of medication errors. This highlights the importance of embracing technological innovations. That leads to an emphasis on the technical components of the healthcare system, such as the adoption of electronic health records (EHRs), which reduce errors. EHRs have revolutionized healthcare delivery by facilitating simple communication between various healthcare workers, leading to accurate medication reconciliation (Mutair et al., 2021). Electronic health records should be used regularly in nursing homes and for older people. These make it simple to keep track of the medications the client is taking and the ones that have caused issues in the past (Bates & Zebrowski, 2022). Timely evaluation of those who may have negative consequences has proven to be another challenge. In situations like this, telemedicine could be beneficial. When a patient seems to be experiencing difficulties, facility staff could notify a physician to assess the situation and make necessary adjustments.
Furthermore, regular medication reviews by the doctor or pharmacist are one way to address medication errors resulting from PIM and PRN (Nadeau et al., 2021). PRN medication users who are older need to be monitored more attentively. In the end, determining whether PIM and PRN are present is critical in determining adherence obstacles and improving patient comprehension of medication indications and appropriate use. Clients should be asked about the use of all medications at every visit, and prescribers should carefully review the medication list to avoid PIM use resulting from PRN medication mistakes (Koçak et al., 2022). Employing fixed-combination goods, lowering the dose rate, and minimizing or halting drugs that are potentially hazardous or no longer helpful are some strategies that should be implemented to lessen the pill burden.
Role of Stakeholders and Interdisciplinary Collaboration in Patient Safety Enhancement
Cooperation between various stakeholders is necessary for efficient coordination to promote safety improvements in nursing homes. Nurses are essential to promoting harmony because they are crucial to patient care. While creating and maintaining standardized medication reconciliation procedures, nurses should actively involve pharmacists, doctors, and other healthcare workers (Vos et al., 2020). This interprofessional collaboration ensures a holistic approach to managing medications. It will improve accuracy and reduce errors while making it simple to take advantage of every stakeholder's area of expertise. One essential component of teamwork to improve safety is patient involvement. It is also essential to actively involve clients as collaborators in their care. It is a more practical approach to enable people to provide essential details about their prescription drugs and medical background, assisting the caregiver in making well-informed decisions (Vos et al., 2020). Quality improvement teams and hospital administrators must also be actively involved. Hospital administrators can facilitate the integration of technology. They are also crucial in supporting the significance of standardized protocols and providing financing for training programs. Teams for quality improvement are also important. They are essential for determining how successful safety initiatives can be.
Integrated Synthesis of Strategies for Improving Medication Safety in Nursing Homes
In nursing homes, tackling medication errors and improving patient safety necessitates a multifaceted and cooperative approach. Errors are caused mainly by inadequate medication reconciliation procedures, characterized by poor communication and little patient involvement. Nonetheless, reducing these risks has emerged as the primary goal of any healthcare system. It necessitates developing critical, evidence-based solutions, like implementing EHRs and standardized procedures. As front-line patient care providers, nurses are essential in organizing activities, improving the accuracy of medication reconciliation, and promoting patient empowerment. The importance of including a variety of stakeholders is also underscored.
Reference List
Bates, D. W., & Zebrowski, J. (2022). Medication safety in nursing home patients. BMJ Quality & Safety, 31(12), 849-852.
Koçak, F. Ö. K., Taşkıran, E., Öztürk, Z. K., & Şahin, S. (2022). Potentially Inappropriate Medication Use among Nursing Home Residents: Medication Errors Associated with Pro re nata Medications and the Importance of Pill Burden. Annals of geriatric medicine and research, 26(3), 233–240. https://doi.org/10.4235/agmr.22.0096
Mutair, A. A., Alhumaid, S., Shamsan, A., Zaidi, A. R. Z., Mohaini, M. A., Al Mutairi, A., ... & Al-Omari, A. (2021). The effective strategies to avoid medication errors and improving reporting systems. Medicines, 8(9), 46.
Nadeau, M. E., Henry, J. L., Lee, T. C., Bortolussi-Courval, É., Goodine, C., & McDonald, E. G. (2021). Spread and scale of an electronic deprescribing software to improve health outcomes of older adults living in nursing homes: study protocol for a stepped wedge cluster randomized trial. Trials, 22(1), 763. https://doi.org/10.1186/s13063-021-05729-0
Vos, J. F., Boonstra, A., Kooistra, A., Seelen, M., & van Offenbeek, M. (2020). The influence of electronic health record use on collaboration among medical specialties. BMC health services research, 20(1), 1-11.
Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors and contributing factors among nurses: a cross sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC nursing, 19(1), 1-9.