Understanding the impact of supervision on reducing medication risks: an interview study in long-term elderly care

Area of Science:

• Healthcare management
• Patient safety
• Medication safety

Background:

• Dutch Health Care Inspectorate (IGZ) identified significant medication safety risks in elderly care facilities in 2009.
• Despite identified risks, a contradiction emerged between reduced observed risks and an increase in self-reported medication incidents by 2010.
• This study aimed to reconcile the discrepancy between reported incidents and observed risk reduction in medication safety.

Purpose of the Study:

• To investigate factors explaining the paradox of increased medication safety incident reports alongside reduced observed risks.
• To understand the impact of supervision and reporting culture on medication safety in elderly care.

Main Methods:

• A mixed-methods study involving semi-structured interviews with healthcare professionals from ten care facilities.
• Qualitative data from interviews were combined with quantitative risk assessments per facility.
• Outcome measures included medication safety risk rates, perceptions of incident reporting, safety levels, improvement measures, and supervision effectiveness.

Main Results:

• Three key themes explained the contradiction: improved medication safety activities, changes in incident reporting culture, and the impact of supervision.
• Supervision by the IGZ prompted elderly care facilities to actively reduce medication risks.
• A cultural shift towards increased incident reporting led to a higher number of reported events.

Conclusions:

• Supervision enhanced risk-reduction actions and fostered a greater willingness to report medication safety incidents.
• The rise in reported incidents reflects a positive development towards a safer medication culture, rather than an increase in actual risks.
• Enhanced reporting and supervisory focus contribute to improved medication safety outcomes in elderly care settings.