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Nurses in municipal care of the elderly act as pharmacovigilant intermediaries: A qualitative study of medication management
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.ORCID iD: 0000-0001-7490-6735
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.ORCID iD: 0000-0002-8793-6084
Karolinska Institutet, Stockholm.
Karolinska Institutet, Stockholm.
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2016 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 34, no 1, 37-45 p.Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Objective: To explore registered nurses experience of medication management in municipal care of the elderly in Sweden, with a focus on their pharmacovigilant activities. Design: A qualitative approach using focus-group discussions was chosen in order to provide in-depth information. Data were analysed by qualitative content analysis. Setting: Five focus groups in five different long-term care settings in two regions in Sweden. Subject: A total of 21 registered nurses (RNs), four men and 17 women, aged 27-65 years, with 4-34 years of nursing experience. Results: The findings reveal that RNs in municipal long-term care settings can be regarded as "vigilant intermediaries" in the patients drug treatments. They continuously control the work of staff and physicians and mediate between them, and also compensate for existing shortcomings, both organizational and in the work of health care professionals. RNs depend on other health care professionals to be able to monitor drug treatments and ensure medication safety. They assume expanded responsibilities, sometimes exceeding their formal competence, and try to cover for deficiencies in competence, experience, accessibility, and responsibility-taking. Conclusion: The RNs play a central but also complex role as "vigilant intermediaries" in the medication monitoring process, including the issue of responsibility. Improving RNs possibility to monitor their patients drug treatments would enable them to prevent adverse drug events in their daily practice. New strategies are justified to facilitate RNs pharmacovigilant activities. Key points This study contributes to the understanding of registered nurses (RNs) role in medication management in municipal care of the elderly (i.e. detecting, assessing, and preventing adverse drug events or any drug-related problems).RNs can be considered to be "vigilant intermediaries" in elderly patients drug treatments, working at a distance from staff, physicians, and patients. RNs occasionally take on responsibilities that exceed their formal competence, with the patients best interests in mind. In order to prevent adverse drug events in municipal care of the elderly, new strategies are justified to facilitate RNs pharmacovigilant activities. 

Place, publisher, year, edition, pages
2016. Vol. 34, no 1, 37-45 p.
Keyword [en]
Adverse drug event, drug monitoring, elderly, general practice, nurse's role, patient safety, pharmacovigilance, qualitative research, Sweden
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-31348DOI: 10.3109/02813432.2015.1132891ISI: 000372023200007Scopus ID: 2-s2.0-84960474361OAI: oai:DiVA.org:mdh-31348DiVA: diva2:914591
Available from: 2016-03-24 Created: 2016-03-24 Last updated: 2017-01-31Bibliographically approved
In thesis
1. Pharmacovigilance in municipal elderly care: From a nursing perspective
Open this publication in new window or tab >>Pharmacovigilance in municipal elderly care: From a nursing perspective
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Medication management constitutes a large part of registered nurses' (RNs) daily work in municipal elderly care. They are responsible for monitoring multimorbid older persons with extensive treatments, and they often work alone, without daily access to physicians. RNs’ drug monitoring is, in this thesis, based on the concept of pharmacovigilance. Pharmacovigilance is about the science and the activities that aim to improve patient care and safety in drug use, that is, to detect, assess, understand and prevent drug-related problems.

The overall aim was to explore conditions for pharmacovigilance from a nursing perspective, focusing on implications of RNs’ competence and use of a computerized decision support system (CDSS). Both quantitative and qualitative research methods were used, including a questionnaire (I), focus group discussions (II), individual interviews (III) and an intervention study (IV). In total 216 RNs and 54 older persons participated from 13 special accommodations, located in three different regions.

RNs who had completed further training in pharmacovigilance rated their medication competence higher than those who had not. However, there was no difference between groups in the number of pharmacovigilant activities they performed in clinical practice (I). The RNs appeared to act as “vigilant intermediaries” in drug treatment. They depended on the nursing staff's observations of drug-related problems. The RNs continuously controlled the work of staff and physicians, and attempted to compensate for shortcomings in competence, accessibility and continuity (II). RNs’ use of a CDSS was found to affect drug monitoring, including aspects of time, responsibility, standardization of the work, as well as access to knowledge and opportunities for evidence-based care (III). The CDSS detected significantly more drug-related problems when conducting medication reviews, than the RNs did. Nevertheless, this did not result in any significant improvement in the quality of drug use in the follow up, three and six months later (IV).

This thesis contributes to the recognition of pharmacovigilance from a nursing perspective. Increased medication competence seems to be insufficient to generate pharmacovigilant activities. RNs depend on other health care professionals and organizational conditions in order to perform their work. A CDSS has the potential to support RNs, both in structured medication reviews and in daily clinical practice. Inter-professional collaboration is crucial, with or without a CDSS, and the entire team needs to be aware of and take responsibility. Other important conditions is the existence of well-functioning communication channels, competence across the team, and established procedures based on current guidelines.

Place, publisher, year, edition, pages
Eskilstuna: Mälardalen University Press, 2017
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 222
Keyword
competence, computerized decision support systems, content analysis, drug monitoring, inter-professional collaboration, nurse, older person, patient, pharmacovigilance, pharmacovigilant activities, phenomenography
National Category
Medical and Health Sciences Health Sciences
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-34750 (URN)978-91-7485-309-4 (ISBN)
Public defence
2017-03-24, Filen, Mälardalens högskola, Eskilstuna, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2017-01-31 Created: 2017-01-31 Last updated: 2017-03-03Bibliographically approved

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