Feasibility of a practical nurse administered risk assessment tool for drug-related problems in home care

Dimitrow, Maarit; Leikola, Saija; Kivelä, Sirkka‐Liisa; Passi, Sanna; Lukkari, Pirjo; Airaksinen, Marja

doi:10.1177/1403494815591719

Cited by 6 publications

(10 citation statements)

References 13 publications

(14 reference statements)

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“…The Lohja Home Care unit presents a typical home care system within publicly funded healthcare in Finland covering the entire population [17]. The home care unit is divided into five service areas, each having a leading nurse, nurses and practical nurses (PNs) who mostly conduct home visits [18, 19]. Lohja is a homogenous municipality, without major regional socioeconomic differences.…”

Section: Methodsmentioning

confidence: 99%

“…First, PNs were trained to screen clinically significant DRPs, i.e., DRPs needing intervening actions, during their routine home visits and report their findings to the home care team consisting of a leading nurse, nurses and PNs, which forwarded the risk screenings to the coordinating pharmacist (Fig. 1) [19, 21]. In the DRP risk screening at home, PNs interviewed their clients by using the Drug Related Problem Risk Assessment Tool (DRP-RAT) [21].…”

Section: Methodsmentioning

confidence: 99%

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Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial

et al. 2019

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BackgroundAs populations are aging, a growing number of home care clients are frail and use multiple, complex medications. Combined with the lack of coordination of care this may pose uncontrolled polypharmacy and potential patient safety risks. The aim of this study was to assess the impact of a care coordination intervention on medication risks identified in drug regimens of older home care clients over a one-year period.MethodsTwo-arm, parallel, cluster randomized controlled trial with baseline and follow-up assessment at 12 months. The study was conducted in Primary Care in Lohja, Finland: all 5 home care units, the public healthcare center, and a private community pharmacy. Participants: All consented home care clients aged > 65 years, using at least one prescription medicine who were assessed at baseline and at 12 months. Intervention: Practical nurses were trained to make the preliminary medication risk assessment during home visits and report findings to the coordinating pharmacist. The coordinating pharmacist prepared the cases for the triage meeting with the physician and home care nurse to decide on further actions. Each patient’s physician made the final decisions on medication changes needed.Outcomes were measured as changes in medication risks: use of potentially inappropriate medications and psychotropics; anticholinergic and serotonergic load; drug-drug interactions.ResultsParticipants (n = 129) characteristics: mean age 82.8 years, female 69.8%, mean number of prescription medicines in use 13.1. The intervention did not show an impact on the medication risks between the original intervention group and the control group in the intention to treat analysis, but the per protocol analysis indicated tendency for effectiveness, particularly in optimizing central nervous system medication use. Half (50.0%) of the participants with a potential need for medication changes, agreed on in the triage meeting, had none of the medication changes actually implemented.ConclusionThe care coordination intervention used in this study indicated tendency for effectiveness when implemented as planned. Even though the outcome of the intervention was not optimal, the value of this paper is in discussing the real world experiences and challenges of implementing new practices in home care.Trial registrationClinicalTrials.gov (NCT02545257). Registered September 9 2015.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial

et al. 2019

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“…The coordinating pharmacist organized trainings for PNs related to the recruitment process, medication reconciliation [ 28 ] and use of clinical tests. PNs were also trained on the content and use of the Drug-Related Problem Risk Assessment Tool (DRP-RAT) [ 8 , 29 ] and about Lohja Home Care Unit’s principles in medication management [ 30 ].…”

Section: Methodsmentioning

confidence: 99%

“… Comprehensive medication review (CMR) conducted by a qualified pharmacist (TT, SL) Patient information: medication list, DRP-RAT and GFR results, diagnosis, laboratory test results. Tools used: As in MR, complemented by client’s clinical interview [ 20 , 48 ] Coordinating pharmacist Trainings of the PNs for the recruitment process, CoMM and use of DRP-RAT (MD) Meetings, discussions, personal guidance, DRP-RAT training [ 29 ] Coordinating and organizing processes for CoMM Constructing the CoMM structure through observations, meetings, contacts and negotiations with organizations, health care professionals, researchers and home care clients involved, organizing processes and interactive training, providing training, guidance and feedback, reflecting the literature and guidelines on geriatric care and pharmacotherapy Preparing triage meetings with the leading home care physician to decide on actions for clients with clinically significant DRPs Prescription review findings (from SFINX and Salko databases) and DRP-RAT results. Leading home care physician Triage meetings with the coordinating pharmacist to decide on actions for clients with clinically significant DRPs (50–70 cases per triage meeting of 2 h) Prescription review findings (from SFINX and Salko databases) and DRP-RAT results.…”

Section: Methodsmentioning

confidence: 99%

Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness

et al. 2018

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BackgroundThe magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure.MethodsHealth care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession’s existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design.DiscussionThe new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50–70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients’ physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure.The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources.Trial registrationThe study is registered in the Clinical Trials.gov (NCT02545257). Registration date September 9 2015.

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“…30 However, this cannot be considered as an explanation in this study as the HC clients had several DRPs (an average of 3.1 potential DRPs per client [range = 1-8]). As a result of a strict validation process of the items included in DRP-RAT, [4][5][6]11 all items (including the number of medicines and daily doses) are indicators for high risk of DRPs, and thus, this study picked out the most significant risk predicting factors that should be prioritized in medication risk management among older adults. It also must be noticed that even one medicine alone may cause clinically significant risks and, thus, the number of medicines alone is not adequate criterion for predicting risks for medication misadventures.…”

Section: Symptoms Suggestive Of Adrs As the Highest Priority Risks Fomentioning

confidence: 99%

Can Practical Nurses Identify Older Home Care Clients at Risk of Drug-Related Problems–Geriatricians’ Appraisal of Their Risk Screenings: A Pilot Study

Dimitrow

Puustinen²,

Viikari

et al. 2018

Journal of Pharmacy Technology

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Background: Home care (HC) clients are increasingly older, have many chronic diseases, and use multiple medicines and thus are at high risk for drug-related problems (DRPs). Objective: Establish the sensitivity of practical nurse (PN) administered DRP risk assessment tool (DRP-RAT) compared with geriatrician's assessment of the medical record. Identify the clinically most significant DRPs needing action. Methods: Twenty-six PNs working in HC of Härkätie Health Center in Lieto, Finland, 46 HC clients (≥65 years), and a geriatrician participated in this pilot study. The geriatrician reviewed HC clients' medications using 3 different methods. The reviews were based on the following: (1) the PN's risk screening (ie, PN-completed DRP-RAT) and medication list, (2) health center's medical records, and (3) methods 1 and 2 together. The main outcome was the number of "at-risk patients" (ie, the patient is at risk of clinically significant DRPs) by using each review method. Secondary outcomes were clinically most significant DRP-risk predicting factors identified by the geriatrician. Results: The geriatrician reviewed 45 clients' medications using all 3 methods. Based on PN-completed DRP-RAT and medication list, 93% (42/45) of the clients were classified as "at-risk patients." Two other review methods resulted in 45/45 (100%) "at-risk patients." Symptoms suggestive of adverse drug reactions were the most significant risk predicting factors. Small sample size limits the generalizability of the results. Conclusions: The PN-completed DRP-RAT was able to provide clinically important timely patient information for clinical decision making. DRP-RAT could make it possible to more effectively involve PNs in medication risk management among older HC clients.

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Feasibility of a practical nurse administered risk assessment tool for drug-related problems in home care

Abstract: The Drug-Related Problem Risk Assessment Tool turned out to be feasible among practical nurses. The brief training on the content and use of the tool seems to be sufficient for ensuring reliable use of the tool.

Cited by 6 publications

References 13 publications

Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial

Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial

Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness

Can Practical Nurses Identify Older Home Care Clients at Risk of Drug-Related Problems–Geriatricians’ Appraisal of Their Risk Screenings: A Pilot Study

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