Tinne Dilles

Barriers for Nurses to Safe Medication Management in Nursing Homes

PURPOSE This study aims to identify and compare the relevance of barriers that nurses in nursing homes experience in medication management in Belgium. DESIGN The mixed-method study started with an expert meeting in November 2008 and was followed by a cross-sectional survey in February-March 2009, questioning 246 nurses and 270 nurse assistants in 20 nursing homes. METHODS Twelve nurses represented nursing homes in an expert meeting and listed all barriers that might cause suboptimal medication management. Based on the results, a survey was developed in which respondents could indicate whether they were involved in a particular stage of the medication process and if yes, rate the relevance of the barriers in that stage on a continuous scale, varying from 1 =no barrier to 10 =strong barrier. Barriers scored 7 or more were defined as strong. FINDINGS Nurses experienced a large number of barriers to safe medication management related to the nurse, organization, interdisciplinary cooperation, or to the patient and family. In preparing medication, medication administration and monitoring, being interrupted, not knowing enough on interactions, and barriers in interdisciplinary cooperation caused the most hindrance. In general, barriers in medication monitoring scored the strongest. CONCLUSIONS In order to improve safe medication management by tailored interventions in nursing homes, through the use of a standard questionnaire, nurses and nurse assistants can give an overview of barriers they experience and rate their relevance. Nurses and nurse assistants had different opinions on the relevance of barriers, especially in the stage of medication monitoring. Job expectations in medication management were not always clear, creating additional barriers in medication safety. CLINICAL RELEVANCE This study provides an overview of potential barriers to safe medication management in nursing homes, which can be addressed in practice. The relevance scoring of the barriers enables prioritization.

Nursing home research: the first International Association of Gerontology and Geriatrics (IAGG) research conference.

The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations.

Staff Nurses’ Perceptions and Experiences about Structural Empowerment: A Qualitative Phenomenological Study

The aim of the study reported in this article was to investigate staff nurses’ perceptions and experiences about structural empowerment and perceptions regarding the extent to which structural empowerment supports safe quality patient care. To address the complex needs of patients, staff nurse involvement in clinical and organizational decision-making processes within interdisciplinary care settings is crucial. A qualitative study was conducted using individual semi-structured interviews of 11 staff nurses assigned to medical or surgical units in a 600-bed university hospital in Belgium. During the study period, the hospital was going through an organizational transformation process to move from a classic hierarchical and departmental organizational structure to one that was flat and interdisciplinary. Staff nurses reported experiencing structural empowerment and they were willing to be involved in decision-making processes primarily about patient care within the context of their practice unit. However, participants were not always fully aware of the challenges and the effect of empowerment on their daily practice, the quality of care and patient safety. Ongoing hospital change initiatives supported staff nurses’ involvement in decision-making processes for certain matters but for some decisions, a classic hierarchical and departmental process still remained. Nurses perceived relatively high work demands and at times viewed empowerment as presenting additional. Staff nurses recognized the opportunities structural empowerment provided within their daily practice. Nurse managers and unit climate were seen as crucial for success while lack of time and perceived work demands were viewed as barriers to empowerment.

Do informal caregivers for elderly in the community use support measures? A qualitative study in five European countries

BackgroundInformal caregivers are essential figures for maintaining frail elderly at home. Providing informal care can affect the informal caregivers’ physical and psychological health and labour market participation capabilities. They need support to prevent caregiver burden. A variety of existing support measures can help the caregiver care for the elderly at home, but with some limitations. The objective of this review was to explore the experiences of informal caregivers caring for elderly in the community with the use of supportive policy measures in Belgium and compare these to the experiences in other European countries.MethodsAn empirical qualitative case study research was conducted in five European countries (Belgium, The Netherlands, Luxembourg, France and Germany). Semi-structured interviews were conducted with informal caregivers and their dependent elderly. Interview data from the different cases were analysed. In particular data from Belgium was compared to data from the cases abroad.ResultsFormal services (e.g. home care) were reported to have the largest impact on allowing the caregiver to care for the dependent elderly at home. One of the key issues in Belgium is the lack of timely access to reliable information about formal and informal services in order to proactively support the informal caregiver. Compared to the other countries, informal caregivers in Belgium expressed more difficulties in accessing support measures and navigating through the health system. In the other countries information seemed to be given more timely when home care was provided via care packages.ConclusionTo support the informal caregiver, who is the key person to support the frail elderly, fragmentation of information regarding supportive policy measures is an important issue of concern.

Postpartum weight trajectories in overweight and lean women

BACKGROUND overweight and obesity in women of reproductive age are increasing and are often linked with excessive weight gain in pregnancy and weight retention after birth. Studies on spontaneous maternal weight trajectory after childbirth are scarce. OBJECTIVE we describe womens spontaneous weight trajectory during the first six weeks of the postpartum period and its relationship between Body Mass Index and socio-demographical, behavioural and psychological variables. DESIGN data from 212 women who gave birth in three regional hospitals were collected prospectively between December 2015 and February 2016. Potential determinants were examined during pregnancy and the postpartum period at four and six weeks after childbirth. Descriptive statistics and a linear multivariate regression model were used. Early postnatal weight retention (PWR) was defined as the difference between the maternal weight six weeks after childbirth and the pre-pregnancy weight (kg). MEASUREMENTS AND FINDINGS mean PWR at six weeks after childbirth was 3.3kg (SD 4.1), with a range between -7 and +16.2kg; 81% reported some weight retention (PWR>0kg), and 36% showed a high weight retention (PWR≥5kg). Women with a BMI <25kg/m2 showed a significantly higher mean PWR six weeks after childbirth compared to women with a BMI ≥25kg/m2 (4.0kg versus 1.6kg, p=0.002). There was a significant correlation between maternal weight retention and gestational weight gain (GWG) (B=0.65, p<0.001) and pre-pregnancy body mass index <25kg/m2 (B=1.12, p=0.017), six weeks after childbirth. KEY CONCLUSIONS weight retention six weeks after childbirth is associated with pre-pregnancy BMI and GWG, but contrary to expectations, lean women with excessive GWG tended to retain most weight after childbirth. No significant associations with several socio-demographical, behavioural and psychological variables were found. IMPLICATIONS FOR PRACTICE weight management strategies around pregnancy should not be limited to overweight and obese mothers. Women with pre-pregnancy BMI <25kg/m2 require equal attention to prevent postnatal weight retention.

SelfMED: Self‐Administration of Medication in Hospital: A Prevalence Study in Flanders, Belgium

BACKGROUND Self-management is a key element in regaining and maintaining health. However, during hospitalization it becomes less obvious. Patient self-administration of medication during hospitalization is suggested to be beneficial to patient satisfaction, adherence to pharmacotherapy, and self-care competence. OBJECTIVES This study aimed to examine the prevalence of self-administration of medication during hospitalization, and possible contributing factors. DESIGN AND SETTING A cross-sectional observational study was conducted in 12 Belgian hospitals from February 2015 until June 2015. PARTICIPANTS Data were collected on all hospitalized patients at 57 wards, based in 12 hospitals. DATA COLLECTION A structured questionnaire at ward level and patient level on medication management, self-administration of medication, and rationale for prohibiting or allowing patients to self-administer their medication was conducted in consultation with the head nurse. RESULTS Of the 1,269 patients participating in this study, 22% self-administered at least one medicine during hospitalization and 13.8% self-administered at least 50% of their total amount of medication. In the opinion of the head nurse, 40.9% of the hospitalized patients would have been able to self-administer their medication during hospitalization. Only a few wards had an available procedure and screening tool to assess the competence of the patients to self-administer their medication. This did not affect the prevalence of self-administration. Self-administration occurred significantly more at surgical short-stay wards, compared to other wards. The self-administering patients were on average younger and female and had a lower number of different medications per day before and during hospitalization. These patients had a good health status and were independent to mildly dependent on nurses on the ward. Related factors were used to provide a multivariate logistic regression model. CONCLUSIONS Sometimes self-administration of medication was allowed. According to the surveyed nurses, however, more patients would be able to self-administer their medication during hospitalization. There seems to be a lack of procedures and screening tools to assess the competence or appropriateness of patients to self-administer their medication. CLINICAL RELEVANCE This study provides new knowledge about the prevalence of self-administration of medication, contributing factors, the types of self-administered medications, and the organization of self-administration of medication on different wards.

Evolution of drug utilization in nursing homes in Belgium

In 2005, the PHEBE study highlighted the problem of polypharmacy and the emerging use of psychotropic medication in nursing home residents (PHEBE 1). In 2011, new collected data were compared (PHEBE 2). The total mean number of prescriptions in PHEBE 1 was 8.4, containing a mean of 7.6 for chronic medication only. For PHEBE 2 this was 8.6 for total and 8.1 for chronic medication. In both investigations (2005-2011, resp.) the main categories were ‘Nervous system’ (88.3-89.2%), followed by ‘Cardiovascular system’ (78.0-84.8%) and ‘Alimentary tract and metabolism’ (81.1-83.2%). This study found that polypharmacy remains a major problem in residential care. The use of chronic medication further increased with a high consumption of psychotropic medication, beta-blockers and laxatives.

Autonomy and social functioning of recently admitted nursing home residents.

ABSTRACT Objectives: This paper examines recently admitted nursing home residents’ practical autonomy, their remaining social environment and their social functioning. Method: In a cross-sectional design, 391 newly admitted residents of 67 nursing homes participated. All respondents were ≥65 years old, had mini-mental state examination ≥18 and were living in the nursing home for at least 1 month. Data were collected using a structured questionnaire and validated measuring tools. Results: The mean age was 84, 64% were female, 23% had a partner, 80% children, 75% grandchildren and 59% siblings. The mean social functioning score was 3/9 (or 33%) and the autonomy and importance of autonomy score 6/9 (or 67%). More autonomy was observed when residents could perform activities of daily living more independently, and cognitive functioning, quality of life and social functioning were high. Residents with depressive feelings scored lower on autonomy and social functioning compared to those without depressive feelings. Having siblings and the frequency of visits positively correlated with social functioning. In turn, social functioning correlated positively with quality of life. Moreover, a higher score on social functioning lowered the probability of depression. Conclusion: Autonomy or self-determination and maintaining remaining social relationships were considered to be important by the new residents. The remaining social environment, social functioning, quality of life, autonomy and depressive feelings influenced each other, but the cause--effect relation was not clear.

The willingness and attitude of patients towards self-administration of medication in hospital:

Background: Literature suggests a positive impact of self-administration of medication during hospitalization on medication adherence and safety, and on patient satisfaction. However, self-administration is not a common practice in Belgian hospitals. The aim of this study was to describe patients’ willingness towards self-administration of medication while in hospital. Methods: A cross-sectional observational study was conducted in three Belgian hospitals in November and December 2015. All patients of 14 randomly selected wards were asked to participate. The structured questionnaire comprised patient characteristics, their willingness and attitude towards self-administration of medication, perceived ability to self-administer during hospitalization, and prerequisites and perceived consequences. Results: In total, 124 patients participated (36% of all eligible patients). The main reasons not to participate were the patients’ physical and mental condition (30%) and the absence of patients during the time of data collection (23%). The majority of the 124 participating patients had a positive attitude towards the implementation of self-administration; 83.9% were willing to self-administer their medication while in hospital. Most important prerequisites were self-administration at home before and after hospitalization, patients’ motivation, and a regular evaluation of the patients’ competences. Patients acknowledged benefits such as an increase in autonomy, independence and medication knowledge. Patients did not expect self-administration would cause important safety issues. Conclusion: The majority of patients, capable of participating in the study, would want to self-administer medication during hospitalization. They had a positive attitude towards self-administration of medication. Nevertheless, patients stated important conditions which need to be considered in order to implement self-administration.

An Evidence-Based Procedure for Self-Management of Medication in Hospital: Development and Validation of the SelfMED Procedure

Aim: To develop and validate a procedure for self-management of medication by patients whilst in hospital. Background: Self-management of medication allows patients to self-manage their medication in a controlled and supportive hospital environment. This practice is encouraged worldwide, yet an evidence-based procedure to evaluate the ability of patients to self-manage and to monitor and support self-management are absent. Methods: The evidence-based procedure for self-management of medication (SelfMED) was developed based on previous conducted qualitative research, literature review, and the current regulation. It was validated by healthcare providers and a multidisciplinary expert meeting. Questions within the procedure that could be biased were tested for inter-rater reliability. Results: First, the SelfMED procedure was developed. It consists of a stepped assessment of patient’s competencies for self-management performed by healthcare providers and the patient. When self-management is allowed, the SelfMED monitoring tool monitors the patient’s intake of self-managed medication. Secondly, the procedure was revised for clarity, appropriateness, and face validity by five healthcare providers and a multidisciplinary expert meeting, resulting in the final version. Thirdly, three questions from the final version were tested for interrater reliability. Cohen’s Kappa showed moderate to strong levels of agreement. Conclusions: The developed SelfMED procedure provides an evidence based approach of facilitating self-management of medication. The content of the procedure was found valid to evaluate the patient’s ability to self-manage and to monitor them while self-managing.