Store ulikskapar i innhald, utforming og kvalitet på dei generelle skriftelege direktiva

Abstract

P.r.n. medication in nursing homes -varying content, formulation and quality in administration guidelinesBackground: P.r.n. administration guidelines, prepared by the nursing home physician, are used by nursing home staff when the nursing home physician is not present. Concerns are expressed that patient safety can be threatened by varying quality of these guidelines.Objective: To describe the content and the quality of p.r.n. administration guidelines in Bergen municipality.Method: All 33 nursing homes in the municipality of Bergen were requested to send copies of their p.r.n. administration guidelines. A content analysis of the guidelines was thereafter performed using SPSS. Results:The 24 p.r.n. administration guidelines contained a total of 39 indications and 51 medicines. The median number of indications for a guideline was 11.5 (range 3-17), and the median number of medicines was 13 (range 3-21). For three of four medicines, strength and a clear dosage were given. Maximal dosage and when the physician should be called upon were given for 61% and 37% of the medicines, respectively. Conclusion:Several choices of medicines for each indication, and unclear information regarding strength, dosage and when to call upon the physician, can make decisions about giving p.r.n. medication difficult for nursing home staff and may threaten patients' safety. Further revision of p.r.n. administration guidelines at a managerial level is required to improve and maintain better quality.

‘To give or not to give medication, that is the question.’ Healthcare personnel’s perceptions of factors affecting pro re nata medication in sheltered housing for older adults — a focus-group interview study

“…nursing home). A possibility is to have medications on stock, as is the case in Norwegian nursing homes [2], an approach which may prevent systems within the systems. It could be general lists of medications allowed to store and administrate when required.…”

“…In long-term care institutions, these medications are given based on observations made by healthcare professionals (HCP). «As needed» (as required) medication is also referred to as pro re nata (PRN) [1][2][3]. A cross-sectional study among residents living in residential age care services in Australia, found that the median number of PRN on a medication list was 4 (2-6 interquartile range) [4,5].…”

Forskrivning, bruk og dokumentasjon av effekt

“…De fleste studier gjort på dette feltet tar imidlertid for seg pasientenes faste legemidler, legemidler pasienten skal ta til forhåndsbe-stemte tidspunkter. Få studier har sett naermere på forskrivning og reell bruk av legemidler som tas ved behov (også kalt «eventu-eltmedisin») (10)(11)(12)(13) gemidler er oppført på legemiddelkortene kan dessuten vaere fordelaktig, framfor at pasientene får utlevert behovslegemidler fra såkalte generelle skriftlige direktiv (13). Dette er skriftlige tilleggsprosedyrer utarbeidet på hvert sykehjem, for generell ordinasjon av enkelte legemidler når legen ikke er til stede (14).…”