Variations in drug-related problems detected by multidisciplinary teams in Norwegian nursing homes and home nursing care

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Abstract

Objective: Traditionally, nursing homes have been associated with suboptimal drug therapy and drug-related problems (DRPs). In contrast, less is known about drug safety in homecare. The aim of this study was to describe and compare DRPs in older persons across two care settings: nursing homes and home nursing care.

Design: Cross-sectional study using descriptive and inferential statistics.

Setting: Nursing homes (n = 5) and home nursing care units (n = 8) across nine municipalities in the middle of Norway.

Participants: Multidisciplinary medication reviews for 61 nursing home residents and 93 patients receiving home nursing care performed over the 2013–2014 period, were mapped and examined ( N = 154).

Main outcome measures: DRPs classified by a Norwegian Classification Tool.

Results: In all, 740 DRPs were detected in the total sample, 227 in nursing homes and 513 in home nursing care. DRPs were significantly higher among patients receiving home-based care (Mean =5.5) compared to patients in nursing homes (Mean =3.7, p = 0.002). Among the problem categories, the need for additional drug was most frequent in nursing homes ( p = 0.001), while documentation discrepancies reached the highest numbers in patients receiving home nursing care ( p = 0.000). Additionally, patients in home nursing care had more problems concerning adverse reactions ( p = 0.060); however, this was not statistically significant. Differences in DRP categories leading to changes in the patients’ medication lists were also discovered.

Conclusions: The frequency of unclear documentation and adverse reactions found in the homecare setting is alarming. This is an important issue given the trend in aged care towards caring people in their own homes. Further research is warranted to explore how different care settings may influence the safety of pharmacotherapy for older persons.

Key Points

Drug related problems are a significant cause of concern among patients receiving home nursing care as well as for patients living in nursing homes. The findings of this study showed that:
•Significantly more DRPs were detected among patients receiving home nursing care than patients living in nursing homes.
•While patients living in nursing homes were often undermedicated, documentation discrepancies were more frequent in home nursing care.
•DRP categories leading to changes on the medication lists differed between the settings.

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Most cited references 31

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The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010

Bruce Guthrie, Boikanyo Makubate, Virginia Hernandez Santiago … (2015)

Background The escalating use of prescribed drugs has increasingly raised concerns about polypharmacy. This study aims to examine changes in rates of polypharmacy and potentially serious drug-drug interactions in a stable geographical population between 1995 and 2010. Methods This is a repeated cross-sectional analysis of community-dispensed prescribing data for all 310,000 adults resident in the Tayside region of Scotland in 1995 and 2010. The number of drug classes dispensed and the number of potentially serious drug-drug interactions (DDIs) in the previous 84 days were calculated, and age-sex standardised rates in 1995 and 2010 compared. Patient characteristics associated with receipt of ≥10 drugs and with the presence of one or more DDIs were examined using multilevel logistic regression to account for clustering of patients within primary care practices. Results Between 1995 and 2010, the proportion of adults dispensed ≥5 drugs doubled to 20.8%, and the proportion dispensed ≥10 tripled to 5.8%. Receipt of ≥10 drugs was strongly associated with increasing age (20–29 years, 0.3%; ≥80 years, 24.0%; adjusted OR, 118.3; 95% CI, 99.5–140.7) but was also independently more common in people living in more deprived areas (adjusted OR most vs. least deprived quintile, 2.36; 95% CI, 2.22–2.51), and in people resident in a care home (adjusted OR, 2.88; 95% CI, 2.65–3.13). The proportion with potentially serious drug-drug interactions more than doubled to 13% of adults in 2010, and the number of drugs dispensed was the characteristic most strongly associated with this (10.9% if dispensed 2–4 drugs vs. 80.8% if dispensed ≥15 drugs; adjusted OR, 26.8; 95% CI 24.5–29.3). Conclusions Drug regimens are increasingly complex and potentially harmful, and people with polypharmacy need regular review and prescribing optimisation. Research is needed to better understand the impact of multiple interacting drugs as used in real-world practice and to evaluate the effect of medicine optimisation interventions on quality of life and mortality. Electronic supplementary material The online version of this article (doi:10.1186/s12916-015-0322-7) contains supplementary material, which is available to authorized users.

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Incidence and preventability of adverse drug events among older persons in the ambulatory setting.

Jerry Gurwitz (2003)

Adverse drug events, especially those that may be preventable, are among the most serious concerns about medication use in older persons cared for in the ambulatory clinical setting. To assess the incidence and preventability of adverse drug events among older persons in the ambulatory clinical setting. Cohort study of all Medicare enrollees (30 397 person-years of observation) cared for by a multispecialty group practice during a 12-month study period (July 1, 1999, through June 30, 2000), in which possible drug-related incidents occurring in the ambulatory clinical setting were detected using multiple methods, including reports from health care providers; review of hospital discharge summaries; review of emergency department notes; computer-generated signals; automated free-text review of electronic clinic notes; and review of administrative incident reports concerning medication errors. Number of adverse drug events, severity of the events (classified as significant, serious, life-threatening, or fatal), and whether the events were preventable. There were 1523 identified adverse drug events, of which 27.6% (421) were considered preventable. The overall rate of adverse drug events was 50.1 per 1000 person-years, with a rate of 13.8 preventable adverse drug events per 1000 person-years. Of the adverse drug events, 578 (38.0%) were categorized as serious, life-threatening, or fatal; 244 (42.2%) of these more severe events were deemed preventable compared with 177 (18.7%) of the 945 significant adverse drug events. Errors associated with preventable adverse drug events occurred most often at the stages of prescribing (n = 246, 58.4%) and monitoring (n = 256, 60.8%), and errors involving patient adherence (n = 89, 21.1%) also were common. Cardiovascular medications (24.5%), followed by diuretics (22.1%), nonopioid analgesics (15.4%), hypoglycemics (10.9%), and anticoagulants (10.2%) were the most common medication categories associated with preventable adverse drug events. Electrolyte/renal (26.6%), gastrointestinal tract (21.1%), hemorrhagic (15.9%), metabolic/endocrine (13.8%), and neuropsychiatric (8.6%) events were the most common types of preventable adverse drug events. Adverse drug events are common and often preventable among older persons in the ambulatory clinical setting. More serious adverse drug events are more likely to be preventable. Prevention strategies should target the prescribing and monitoring stages of pharmaceutical care. Interventions focused on improving patient adherence with prescribed regimens and monitoring of prescribed medications also may be beneficial.

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Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies.

H Beijer, C de Blaey (2002)

To establish the percentage hospital admission related to adverse drug reactions (ADRs) from the data available in the literature. Literature search in the Medline database, meta-analysis. From the literature it is revealed that a considerable part of all hospital admissions are related to adverse drug reactions. However, these data are not homogenous, i.e. larger studies display a lower percentage of ADR related hospital admission, while smaller studies display a higher percentage. Subgroup analysis showed that for elderly people the odds of being hospitalised by ADR related problems is 4 times higher than for younger ones (16.6% vs. 4.1%). A considerable part of these hospitalisations can be prevented. Subgroup analysis revealed that in the elderly up to 88% of the ADR related hospitalisations are preventable; for the non-elderly this is only 24%. Comparatively more elderly people are hospitalised than younger ones. Combining these findings, twice as much elderly people are hospitalised by ADR related problems than non-elderly, while preventability of ADR related hospitalisation might yield 7 times more people in the elderly than in the non-elderly. The estimation of the costs of ADR related hospitalisations in the Health Care system in The Netherlands is discussed. Many elderly people are hospitalised by ADR related problems; an important part of these hospitalisations can be avoided.

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Author and article information

Journal

Journal ID (nlm-ta): Scand J Prim Health Care

Journal ID (iso-abbrev): Scand J Prim Health Care

Journal ID (publisher-id): IPRI

Journal ID (publisher-id): ipri20

Title: Scandinavian Journal of Primary Health Care

Publisher: Taylor & Francis

ISSN (Print): 0281-3432

ISSN (Electronic): 1502-7724

Publication date Collection: September 2018

Publication date (Electronic): 23 August 2018

Volume: 36

Issue: 3

Pages: 291-299

Affiliations

[a ] Centre of Care Research Mid-Norway , Steinkjer, Norway;

[b ] Faculty of Nursing and Health Sciences, Nord University , Namsos, Norway;

[c ] Centre for Development of Institutional and Home care Services in Nord- Trøndelag , Stjørdal, Norway;

[d ] Namsos Hospital, Hospital Pharmacy , Namsos, Norway;

[e ] Apotek 1 , Malvik, Norway;

[f ] Department of Laboratory Medicine Children’s and women’s Health, Norwegian University of Science and Technology , Trondheim, Norway;

[g ] Faculty of Health and Occupational Studies, University of Gävle , Gävle, Sweden

Author notes

CONTACT Siri A. Devik siri.a.devik@ 123456nord.no Nord University , Finn Christiansens veg,1, N-7800Namsos, Norway

Article

Publisher ID: 1499581

DOI: 10.1080/02813432.2018.1499581

PMC ID: 6381529

PubMed ID: 30139278

SO-VID: a0cf35d2-36d2-46e4-b059-f932ca5bfa97

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 17 July 2017

Date accepted : 12 June 2018

Page count

Pages: 9, Words: 5997

Funding

This study received funding from Regional Research Fund Mid-Norway.

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Variations in drug-related problems detected by multidisciplinary teams in Norwegian nursing homes and home nursing care

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Most cited references 31

The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010

Incidence and preventability of adverse drug events among older persons in the ambulatory setting.

Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies.

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