Safe drug handling, a basis for patient safety and thus the residents' well-being at the nursing home

This article is written from a Swedish perspective. Hopefully, it can inspire those interested from other countries.

Deviations with medication can have serious consequences for the elderly. Safe routines and good systems to reduce risks make a big difference. The routines for medication management must be known and followed by all so that medication is administered in a safe way.

Foto: Mostphotos

Safe Medication Management

There are many risks in medication management and many deviations are reported in many activities. Medications that are forgotten, the individual receives a double dose or gets the night medicine in the morning. The most serious deviations occur when staff give medication to the wrong person. This can have very dire consequences. Therefore, medication management should be structured in such a way that this type of error is avoided.

Database-based signing systems such as Appva and Alfa KL have started to be used in healthcare. All medications are then registered and signed directly on a writing pad or mobile phone by staff when they are given. The system alerts if the medicine has not been given at the right time. The staff can also notify the nurse through the system if something needs to be refilled.

Digital signing lists provide increased security when it comes to remembering to give medication at the right time. It is usually safest that all medications are available inside the individual's apartment. The risk of confusing people then decreases. If signing lists on paper are used, the risk of forgetting medication increases. Signing lists on paper should always be stored where the medicines are stored.

Medication management in special housing often takes place as a health and medical care intervention. In some cases, however, the individual can be responsible for keeping track of their medications. This is then called self-care. With self-care, the individual can for example ask staff to help get the medications without this needing to be a delegated health and medical care intervention. Self-care assumes that the elderly are clear and tidy. Sometimes someone may have self-care for a single medicine. They might manage their inhaler themselves but need help with the rest of the medication management.

Many times, the tablets come pre-divided in dose bags. If the individual has few medications or often needs to adjust their medications, a pill organizer can be a better alternative. All medications cannot be divided in advance. This may be because the substance is light-sensitive or for other reasons should not be exposed. Liquid medications usually need to be divided at the current time or for a few days at a time. Eye and ear drops are given directly from the package. The same goes for ointments and patches.

The very distribution is surrounded by checks that it is the right person, that the medicine has not already been given, that it is the right time, how it should be given and that the number of tablets matches the prescription. This is not always easy in the rush that prevails in connection with breakfast at a nursing home or a ward. Then it is extra important that staff follow applicable instructions. Tablets are washed down with plenty of liquid. Some medications should not be taken in connection with meals. There may also be other prescriptions around the intake of individual medications. Sometimes the nurse can decide that certain medications should be crushed before they are given.
This decision can only be made by a nurse.

Handling of medications is covered like food by hygiene requirements. Staff must never touch the medicines with their hands. They are most conveniently given via a medicine cup or on a spoon. Then signing should take place immediately after the medicine is given. The fewer staff members who share medications at each sharing occasion, the less risk of a mistake.

On some units, someone is appointed as the main responsible at each sharing occasion. They then double-check that everyone has received their medication. The person who is primarily responsible signs that they have the responsibility on a special list.

Sometimes medication is given as needed. The need should be assessed by a nurse. The nurse should document why the medication was given and an evaluation of the effect of the intake. It is important to evaluate all medications that are started, so that they do not do more harm than good.

Many medications are addictive and thus classified as narcotics. These are surrounded by special safety regulations to avoid abuse.

Sometimes advanced equipment is needed to give medication. It can be about, for example, medication pumps or drip counters. Insulin is often given with special insulin pens to ensure the correct dosage. Oxygen is a medication that, like others, must be prescribed by a doctor. Often a lung specialist is involved in the prescription for it to be done on the right indications. There are a number of aids when it comes to inhaled medication. All of these are counted as medical-technical products and are surrounded by special safety regulations.
Safe Medication Management in the Nursing Home: Caring with Care and Precision

Medication management in nursing homes is one of the most critical aspects of care for elderly people. Elderly people can take several different medications at the same time, and incorrect medication management can have serious consequences. To ensure a high standard of care and minimize risks, it is of utmost importance that nursing homes focus on safe medication management.

The complexity of medication management for the elderly

Many elderly people suffer from various medical conditions and take several medications daily. This polypharmacy increases the complexity of medication management and the risk of medication-related problems. Factors such as decreased cognitive function and impaired vision or hearing can further complicate correct medication use.

Factors contributing to safe medication management

- Proper documentation: It is crucial to have accurate documentation of all medications that the elderly take. This includes dosage, times of administration, and any special instructions.
- Communication: Clear and open communication between healthcare staff, pharmacy, and doctors is important. This includes reporting side effects, changes in the patient's condition, and any problems with medications.
- Medication reviews: Regular medication reviews should be conducted by a doctor or pharmacist to ensure that the elderly are taking the right medications in the right doses. The review should also include an assessment of any interactions between different medications. Some medications are also inappropriate for treating the elderly.
-Correct administration method: Making sure that the medications are administered correctly is important. Some medications can be taken with food, while others should be taken on an empty stomach. Liquid-based medications and tablets have different administration requirements. It is important that the person distributing the medication also ensures that the resident ingest it. Elderly can easily become fumbly and do not always see so well either. The tablets do no good if they end up on the floor or remain in the food leftovers after meals.
- Storage: Medications should be stored in a safe and suitable manner. Heat, moisture, and sunlight can affect the effectiveness of the drugs.
- Patient education: The elderly and their relatives should receive education about the medications being taken. This includes understanding the purpose of each medication, any side effects, and how to take it correctly. If a resident is hesitant about a medication, there may be a reason for it. It may be the wrong medication or the resident may experience unpleasant side effects. Contact a nurse.
- Monitoring: Regular monitoring of the elderly's health and any side effects of the medications is important. If any problems arise, they should be reported and addressed quickly.

The role of care staff

The care staff at the nursing home have a key role when it comes to safe medication management. It is their responsibility to ensure that the medications are administered according to prescription and that the elderly are closely monitored. They should also be well trained in handling emergency situations should a medication-related complication arise.

Safe medication management is crucial for the well-being of the elderly in nursing homes. It requires accuracy, open communication, and a holistic approach to ensure that the elderly receive the medications they need in the right way and that the risks of medication-related problems are minimized. By prioritizing safety and care, nursing homes can continue to provide high-quality care for the elderly.

Read more: Läkemedelsadministrering

Reflection Questions - Safe Medication Management
Care Staff:
- Have you had any serious medication deviations in your unit?
- How is insulin delegation handled?
- Are there other drug treatments where not as many have delegation?

Manager, Nurse, Occupational Therapist, and Physiotherapist:
- Do you have good routines for medication management?
- Where are your weak points if you look at the deviation handling?
- How do you handle serious deviations?
- Does it happen that delegations are revoked?

Residents and Relatives:
- Do you feel that medication management works well in the unit?

Erland Olsson
Specialist Nurse
Sofrosyne - Better care every day.

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