Seniors managing multiple medications: using mixed methods to view the home care safety lens

Abstract

BackgroundPatient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs. This study addresses the medication management issues faced by seniors with chronic illnesses, their family, caregivers, and paid providers within Canadian publicly funded home care programs in Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS).MethodsInformed by a socio-ecological perspective, this study utilized Interpretive Description (ID) methodology and participatory photographic methods to capture and analyze a range of visual and textual data. Three successive phases of data collection and analysis were conducted in a concurrent, iterative fashion in eight urban and/or rural households in each province. A total of 94 participants (i.e., seniors receiving home care services, their family/caregivers, and paid providers) were interviewed individually. In addition, 69 providers took part in focus groups. Analysis was iterative and concurrent with data collection in that each interview was compared with subsequent interviews for converging as well as diverging patterns.ResultsSix patterns were identified that provide a rich portrayal of the complexity of medication management safety in home care: vulnerabilities that impact the safe management and storage of medication, sustaining adequate supports, degrees of shared accountability for care, systems of variable effectiveness, poly-literacy required to navigate the system, and systemic challenges to maintaining medication safety in the home.ConclusionsThere is a need for policy makers, health system leaders, care providers, researchers, and educators to work with home care clients and caregivers on three key messages for improvement: adapt care delivery models to the home care landscape; develop a palette of user-centered tools to support medication safety in the home; and strengthen health systems integration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1193-5) contains supplementary material, which is available to authorized users.

Visiting nurses’ posthospital medication management in home health care: an ethnographic study

“…In such cases, they subsequently asked the GP to write a new prescription. This finding was supported by Lang et al, who also found that patient safety was affected by contextual challenges, which led the staff to devise workarounds to improve medication management despite system barriers, and that nurses needed literacy to navigate in the system to maintain medication safety in the home. In the present study, nurses devised workarounds by adapting their actions to the situation and the individual patient or colleague, rather than stringently adhering to regulations.…”

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“…Medication management during care transitions can have a positive impact on the clinical results of patients (34) . In a Canadian study (35) , there were reports of instructional failures and lack of understanding of patients regarding the purpose and effect of medications in use. Some patients did not remember receiving drug-related explanations, which resulted in unsafe medication usage.…”

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“…15,16 This innovative methodological approach adapts principles and methods from the field of ecological restoration to study safety issues in contemporary health systems from a socio-ecological perspective. 14,17,18 The theoretical rationale for a restorative research approach in health care safety is the premise that today's health care systems are over-fragmented complex adaptive systems that lack systemic integrity due to an imbalance between increasing technology and neglected ecology. 14,17 While the socio-ecological foundations of our restorative research approach constitute a different theoretical base than the critical social theoretical foundations of participatory action research (PAR), both methodological approaches are concerned with empowering communities to generate collective action for positive change.…”