Medication Management in Belgian Residential Care Facilities for Individuals With Intellectual Disability: An Observational Study

Abstract

Organizational aspects of the medication management process (MMP) have been investigated in hospital and nursing home settings. However, the amount of literature on medication management in residential care facilities (RCF) for individuals with ID is limited to two studies from the Netherlands, focusing only on drug administration errors. To assess the organization of the MMP in Belgian RCFs for people with ID, the authors undertook a cross-sectional observational study in 34 Belgian RCFs for people with ID. Structured interviews were performed using a questionnaire: the first part (for the RCF directors) addressed administrative and policy issues. The second (for unit employees) and third parts (for medical office employees) addressed practical aspects of the MMP. The fourth part (for physicians) focused on the physician's role in the MMP, on the therapeutic drug formulary, and on communication with staff and delivering pharmacist. Standard operating procedures concerning the MMP were not available in 32% of the RCFs. About one-quarter of the RCFs did not have a medication error reporting system, and most RCFs did not systematically (i.e., at least annually) review their MMP for failures. Only two participating RCFs were equipped with an electronic prescribing system. The role of the pharmacist was mainly limited to delivery of medication. Medication was mostly administered by nonmedically qualified staff (e.g., educators). Most frequently cited problems by the interviewees were problems in the medication preparation and administration stage. Most frequently cited possible improvement actions were education/sensitization of staff and improved communication among all stakeholders. The authors note that as this study revealed operational inadequacies, problem areas can be identified and targeted quality improvement actions can be undertaken.

Drug administration via enteral feeding tubes in residential care facilities for individuals with intellectual disability: an observational study

“…This is consonant with our previous study on the entire medication management process, where a large variation in procedures was identified between the participating RCFs ( n = 34), and even between units within the same RCF (Joos et al . ).…”

“…educators) (Joos et al . ), which may lead to even more errors. In addition, residents with ID are especially at risk for medication errors because of their high medication use (Idzinga et al .…”

“…In RCFs for people with ID, medication is mainly administered by non-medically trained staff (e.g. educators) (Joos et al 2014), which may lead to even more errors. In addition, residents with ID are especially at risk for medication errors because of their high medication use (Idzinga et al 2009) and the fact that they may not be aware of errors because of their cognitive impairment (van den Bemt et al 2007).…”

Knowledge of staff members of residential care facilities for individuals with intellectual disability on medication administration via enteral feeding tube

“…The fact that in RCFs, medication is mainly administered by non‐medically trained staff (e.g. educators) (Joos et al ) could explain the inadequate guideline knowledge observed in this study. This suggestion is supported by the significantly higher total scores obtained by staff with a nursing degree compared with those without.…”

“…This study provides a strong incentive for the development of tailored educational programmes to increase knowledge of current guidelines among staff of RCFs for people with ID. As those RCFs purchase their medication from community pharmacies (Joos et al ), pharmacists are ideally placed to provide training and advice on medication administration via EFT. Intervention programmes involving a pharmacist have shown to reduce medication errors and/or improve staff's knowledge on medication administration via EFT in RCFs for people with ID (Idzinga et al ), as well as in the hospital (Hanssens et al ; van den Bemt et al ; Bertsche et al ; Dashti‐Khavidaki et al ) and nursing home sector (Stuijt et al ).…”