A qualitative study describing nursing home nurses sensemaking to detect medication order discrepancies

Area of Science:

• Nursing Practice
• Patient Safety
• Healthcare Quality Improvement

Background:

• Medication reconciliation is a critical safety practice during patient transitions.
• Nursing homes utilize both Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) for medication reconciliation.
• Differences in RN and LPN approaches to detecting medication discrepancies are not well understood.

Purpose of the Study:

• To describe differences in sensemaking between RNs and LPNs when detecting medication order discrepancies.
• To explore how educational preparation and scope of practice influence discrepancy identification.

Main Methods:

• Qualitative methodology using semi-structured interviews with 13 RNs and 13 LPNs in 12 Midwestern nursing homes.
• Analysis guided by Weick's Sensemaking theory, employing conventional and directed content analysis.
• Interviews utilized resident transfer vignettes containing medication order discrepancies.

Main Results:

• RNs used explicit clinical reasoning to ensure medication appropriateness, while LPNs focused on comparing medication lists.
• Both groups acknowledged competing demands, but RNs prioritized accuracy and safety, whereas LPNs prioritized time.
• RNs' detailed reasoning and LPNs' list comparison represent distinct approaches to discrepancy detection.

Conclusions:

• RNs play a crucial role in identifying potential resident-harming discrepancies through complex clinical reasoning.
• Both RNs and LPNs are vital for nursing home care and resident safety.
• Assigning nurses to roles based on their unique contributions, particularly RNs for complex reconciliation, is essential for ensuring resident safety.