Deidre Wild

Medication administration errors for older people in long-term residential care

BackgroundOlder people in long-term residential care are at increased risk of medication prescribing and administration errors. The main aim of this study was to measure the incidence of medication administration errors in nursing and residential homes using a barcode medication administration (BCMA) system.MethodsA prospective study was conducted in 13 care homes (9 residential and 4 nursing). Data on all medication administrations for a cohort of 345 older residents were recorded in real-time using a disguised observation technique. Every attempt by social care and nursing staff to administer medication over a 3-month observation period was analysed using BCMA records to determine the incidence and types of potential medication administration errors (MAEs) and whether errors were averted. Error classifications included attempts to administer medication at the wrong time, to the wrong person or discontinued medication. Further analysis compared data for residential and nursing homes. In addition, staff were surveyed prior to BCMA system implementation to assess their awareness of administration errors.ResultsA total of 188,249 medication administration attempts were analysed using BCMA data. Typically each resident was receiving nine different drugs and was exposed to 206 medication administration episodes every month. During the observation period, 2,289 potential MAEs were recorded for the 345 residents; 90% of residents were exposed to at least one error. The most common (n = 1,021, 45% of errors) was attempting to give medication at the wrong time. Over the 3-month observation period, half (52%) of residents were exposed to a serious error such as attempting to give medication to the wrong resident. Error incidence rates were 1.43 as high (95% CI 1.32-1.56 p < 0.001) in nursing homes as in residential homes. The level of non-compliance with system alerts was very low in both settings (0.075% of administrations). The pre-study survey revealed that only 12/41 staff administering drugs reported they were aware of potential administration errors in their care home.ConclusionsThe incidence of medication administration errors is high in long-term residential care. A barcode medication administration system can capture medication administration errors and prevent these from occurring.

Attitudes towards caring for older people: findings and recommendations for practice: In the second part of this article, Angela Kydd and colleagues compare data from two studies to gauge if there has been a change in opinion over a decade

AIM To investigate the attitudes of healthcare professionals towards working with older people, including their perception of how other professionals perceived their work in gerontology. METHOD Data were collected using a 20-item Multifactorial Attitudes Questionnaire (MAQ) in the West of Scotland with a five-point Likert scale for responses ranging from strongly agree to strongly disagree. Questionnaires were distributed to hospitals and community settings by post and by hand in 1999 and 2009, and also by email in 2009. RESULTS In total, 376 healthcare staff working in primary and secondary services not exclusive to older people completed the MAQ in 1999, and 546 staff responded in 2009. The results showed that, although the respondents in 1999 and 2009 were enthusiastic and positive in their approach towards caring for older people, their work carried little professional kudos. Working conditions and the working environment were regarded as detrimental to recruitment of staff in gerontology, and respondents did not think that other health professionals valued their gerontological expertise. CONCLUSION The use of the MAQ in 1999 and 2009 enabled a comparative analysis of two studies completed a decade apart. Comparison of the MAQ results from 1999 and 2009 show that attitudes towards the care of older people as a recognised specialism have remained largely unchanged, despite a decade of major policy changes to include gerontology in pre- and post-registration nurse training. This finding does not bode well for attracting nurses into a career in gerontology. As a consequence, with increasing numbers of older people living in Scotland, and worldwide, the care and wellbeing of this group may be compromised at a time when it is most needed. The lead author (AK) has used the MAQ for an international study with colleagues from Germany, Sweden, Japan, Slovenia and the US, the results of which will be available shortly.

Implementing digital skills training in care homes: a literature review.

This article is the first of a two-part series that informs and describes digital skills training using a dedicated console computer provided for staff and residents in a care home setting. This was part of a programme of culture change in a large care home with nursing in Glasgow, Scotland. The literature review shows that over the past decade there has been a gradual increase in the use of digital technology by staff and older people in community settings including care homes. Policy from the European Commission presents a persuasive argument for the advancement of technology-enabled care to counter the future impact of an increased number of people of advanced age on finite health and social care resources. The psychosocial and environmental issues that inhibit or enhance the acquisition of digital skills in care homes are considered and include the identification of exemplar schemes and the support involved.

Digital skills training in care homes: achievement.

This article describes digital skills training (DST) for staff and later, residents, as part of a programme of culture change in a large care home with nursing in Glasgow. It presents the successes and challenges arising from DST from the perspectives of the two volunteer information technology (IT) champions (Thomas Sloan and John Thomson), who were also staff members. Using their written reports, questionnaires and subsequent conversations, the IT champions recall the challenges and gains for staff and residents as a result of their initial training. This is supplemented by a follow-up on IT activities in the 18 months after the introduction period.