Drug safety for nursing-home residents

Junius-Walker, Ulrike; Krause, Olaf; Thürmann, Petra A.; Bernhard, Simone; Fuchs, Ângela; Sparenberg, Lisa; Wollny, Anja; Stolz, Regina; Haumann, Hannah; Freytag, Antje; Kirsch, C.-M.; Usacheva, Svetlana; Wilm, Stefan; Wiese, Birgitt

doi:10.3238/arztebl.m2021.0297

Cited by 12 publications

(12 citation statements)

References 26 publications

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“…Die Forscher berichteten u. a. von geringer Compliance der Ärzteschaft, die wiederum auf Systembedingungen (z. B. Ärztemangel im ambulanten Bereich) zurückgeführt werden kann [ 37 ].…”

Section: Diskussionunclassified

Pflegeheim-sensitive Krankenhausfälle und Ansätze zur Verringerung der Hospitalisierung von Pflegeheimbewohnerinnen und -bewohnern

Valk-Draad

Bohnet-Joschko

2023

Bundesgesundheitsbl

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Zusammenfassung Hintergrund Interventionen zur Vermeidung von potenziell risikobehafteten Krankenhauseinweisungen aus dem Pflegeheim sind von hoher Bedeutung für Patientensicherheit und Versorgungsqualität. Ein Katalog Pflegeheim-sensitiver Krankenhausfälle (PSK) bildet die Grundlage für die Entwicklung von Handlungsempfehlungen. Methoden In zwei vorangegangenen Forschungsphasen entwickelte ein Expertenpanel einen Katalog mit 58 PSK mittels eines angepassten Delphi-Verfahrens (die RAND/UCLA Appropriateness Methode). Dieses Verfahren wurde von der Nord-Amerikanischen gemeinnützigen Research and Development Organisation (RAND) und Klinikern der Universität von Kalifornien in Los Angeles (UCLA) entwickelt. In der hier vorgestellten dritten Projektphase wurden zunächst in einem Expertenworkshop Interventionsansätze zu deren Reduktion entwickelt. Die Ergebnisse wurden anschließend durch sechs Gutachtende aus themenverwandten Sektoren bewertet, ergänzt und systematisch zur Erstellung von Handlungsempfehlungen verwendet. Mögliche Umsetzungshürden wurden berücksichtigt und der Zeithorizont der Wirksamkeit abgeschätzt. Ergebnis Die Handlungsempfehlungen betreffen Bereiche der Kommunikation, Kooperation, Dokumentation und Versorgungskompetenz sowie einrichtungsbezogene, finanzielle und rechtliche Aspekte. Einzelne Indikationsbündel demonstrieren die Relevanz für das deutsche Gesundheitswesen. Zur Erhöhung der Wirksamkeit empfehlen die Sachverständigen eine sinnvolle Kombination von Handlungsempfehlungen. Diskussion Durch eine Optimierung multidisziplinärer Kommunikation und Kooperation, kombiniert mit einem – auch digitalen – Ausbau der Infrastruktur bei Schaffung einrichtungsbezogener rechtlicher Voraussetzungen und Vergütungsstrukturen, könnten fast 35 % aller Hospitalisierungen aus dem Pflegeheim, rund 220.000 Krankenhausfälle in Deutschland, vermieden werden. Die für Maßnahmen erforderlichen Ausgaben könnten aus Einsparungen durch vermiedene Krankenhausaufenthalte in Höhe von 768 Mio. € refinanziert werden.

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“…Die Forscher berichteten u. a. von geringer Compliance der Ärzteschaft, die wiederum auf Systembedingungen (z. B. Ärztemangel im ambulanten Bereich) zurückgeführt werden kann [ 37 ].…”

Section: Diskussionunclassified

Pflegeheim-sensitive Krankenhausfälle und Ansätze zur Verringerung der Hospitalisierung von Pflegeheimbewohnerinnen und -bewohnern

Valk-Draad

Bohnet-Joschko

2023

Bundesgesundheitsbl

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“…20 Most of the recent pragmatic (ie, conducted under everyday conditions) interventions to facilitate the process of prioritizing and discontinuing medications for older patients with polypharmacy have relied on electronic decision support 21,22 or pharmacist advice. 23 However, many barriers to reducing inappropriate polypharmacy have been identified among physicians, patients, and relatives, leading to major challenges in communication between the stakeholders involved. 24,25 The process of deprescribing is complex and should therefore be promoted not only through better information for health care professionals but also through improved communication between all stakeholders.…”

Section: Introductionmentioning

confidence: 99%

Family Conferences to Facilitate Deprescribing in Older Outpatients With Frailty and With Polypharmacy

et al. 2023

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ImportanceFor older adults with frailty syndrome, reducing polypharmacy may have utility as a safety-promoting treatment option.ObjectiveTo investigate the effects of family conferences on medication and clinical outcomes in community-dwelling older adults with frailty receiving polypharmacy.Design, Setting, and ParticipantsThis cluster randomized clinical trial was conducted from April 30, 2019, to June 30, 221, at 110 primary care practices in Germany. The study included community-dwelling adults aged 70 years or older with frailty syndrome, daily use of at least 5 different medications, a life expectancy of at least 6 months, and no moderate or severe dementia.InterventionsGeneral practitioners (GPs) in the intervention group received 3 training sessions on family conferences, a deprescribing guideline, and a toolkit with relevant nonpharmacologic interventions. Three GP-led family conferences for shared decision-making involving the participants and family caregivers and/or nursing services were subsequently held per patient at home over a period of 9 months. Patients in the control group received care as usual.Main Outcomes and MeasuresThe primary outcome was the number of hospitalizations within 12 months, as assessed by nurses during home visits or telephone interviews. Secondary outcomes included the number of medications, the number of European Union list of the number of potentially inappropriate medication (EU[7]-PIM) for older people, and geriatric assessment parameters. Both per-protocol and intention-to-treat analyses were conducted.ResultsThe baseline assessment included 521 individuals (356 women [68.3%]; mean [SD] age, 83.5 [6.17] years). The intention-to-treat analysis with 510 patients showed no significant difference in the adjusted mean (SD) number of hospitalizations between the intervention group (0.98 [1.72]) and the control group (0.99 [1.53]). In the per-protocol analysis including 385 individuals, the mean (SD) number of medications decreased from 8.98 (3.56) to 8.11 (3.21) at 6 months and to 8.49 (3.63) at 12 months in the intervention group and from 9.24 (3.44) to 9.32 (3.59) at 6 months and to 9.16 (3.42) at 12 months in the control group, with a statistically significant difference at 6 months in the mixed-effect Poisson regression model (P = .001). After 6 months, the mean (SD) number of EU(7)-PIMs was significantly lower in the intervention group (1.30 [1.05]) than in the control group (1.71 [1.25]; P = .04). There was no significant difference in the mean number of EU(7)-PIMs after 12 months.Conclusions and RelevanceIn this cluster randomized clinical trial with older adults taking 5 or more medications, the intervention consisting of GP-led family conferences did not achieve sustainable effects in reducing the number of hospitalizations or the number of medications and EU(7)-PIMs after 12 months.Trial RegistrationGerman Clinical Trials Register: DRKS00015055

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“…Development and evaluation of interventions fit to the complex context of nursing homes in large-sample, longitudinal studies have been suggested beneficial to obtain positive, long-lasting effects on medication safety [ 22 ]. Within hospital settings, multifaceted approaches and inclusion of stakeholders has been found to be associated with a decrease in medication errors and a positive change in patients’ satisfaction [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, findings are contradictory. A recent study investigating a multifaceted intervention to improve medication safety of nursing home residents did not find positive effects on the health status of nursing home residents [ 22 ], contrary to a study aimed to improve medication safety in a hospital setting through a multifaceted interventional strategy [ 23 ]. Overall, studies on interventions to improve medication safety in residential health care for older adults are heterogenous in terms of methodologies with inconclusive results [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Safe Medication in Nursing Home Residents Through the Development and Evaluation of an Intervention (SAME): Protocol for a Fully Integrated Mixed Methods Study With a Cocreative Approach

Juhl¹,

Soerensen²,

Kristensen³

et al. 2023

JMIR Res Protoc

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Background Medication safety is increasingly challenging patient safety in growing aging populations. Developing positive patient safety cultures is acknowledged as a primary goal to improve patient safety, but evidence on the interventions to do so is inconclusive. Nursing home residents are often cognitively and physically impaired and are therefore highly reliant on frontline health care providers. Thus, interventions to improve medication safety of nursing home residents through patient safety culture among providers are needed. Using cocreative partnerships, integrating knowledge of residents and their relatives, and ensuring managerial support could be beneficial. Objective The primary aim of the Safe Medication of Nursing Home Residents Through Development and Evaluation of an Intervention (SAME) study is to improve medication safety for nursing home residents through developing an intervention by gaining experiential knowledge of patient safety culture in cocreative partnerships, integrating knowledge of residents and their relatives, and ensuring managerial support. Methods The fully integrated mixed method study will be conducted using an integrated knowledge translation approach. Patient safety culture within nursing homes will first be explored through qualitative focus groups (stage 1) including nursing home residents, their relatives, and frontline health care providers. This will inform the development of an intervention in a multidisciplinary panel (stage 2) including cocreators representing the medication management process across the health care system. Evaluation of the intervention will be done in a randomized controlled trial set at nursing homes (stage 3). The primary outcome will be changes in the mean scale score of an adapted version of the Danish “Safety Attitudes Questionnaire” (SAQ-DK) for use in nursing homes. Patient safety–related outcomes will be collected through Danish health registers to assess safety issues and effects, including medication, contacts to health care, diagnoses, and mortality. Finally, a mixed methods analysis on patient safety culture in nursing homes will be done (stage 4), integrating qualitative data (stage 1) and quantitative data (stage 3) to comprehensively understand patient safety culture as a key to medication safety. Results The SAME study is ongoing. Focus groups were carried out from April 2021 to September 2021 and the workshop in September 2021. Baseline SAQ-DK data were collected in January 2022 with expected follow-up in January 2023. Final data analysis is expected in spring 2024. Conclusions The SAME study will help not only to generate evidence on interventions to improve medication safety of nursing home residents through patient safety culture but also to give insight into possible impacts of using cocreativity to guide the development. Thus, findings will address multiple gaps in evidence to guide future patient safety improvement efforts within primary care settings of political and scientific scope. Trial Registration ClinicalTrials.gov NCT04990986; https://clinicaltrials.gov/ct2/show/NCT04990986 International Registered Report Identifier (IRRID) DERR1-10.2196/43538

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Drug safety for nursing-home residents

Cited by 12 publications

References 26 publications

Pflegeheim-sensitive Krankenhausfälle und Ansätze zur Verringerung der Hospitalisierung von Pflegeheimbewohnerinnen und -bewohnern

Pflegeheim-sensitive Krankenhausfälle und Ansätze zur Verringerung der Hospitalisierung von Pflegeheimbewohnerinnen und -bewohnern

Family Conferences to Facilitate Deprescribing in Older Outpatients With Frailty and With Polypharmacy

Safe Medication in Nursing Home Residents Through the Development and Evaluation of an Intervention (SAME): Protocol for a Fully Integrated Mixed Methods Study With a Cocreative Approach

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