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Improving posthospital medication management in a Danish municipality: A process evaluation
Mette Geil Kollerup1,2,3, Tine Curtis4,5, Birgitte Schantz Laursen1,2
1Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Journal of Clinical Nursing
|May 19, 2018
Summary
This study evaluated an intervention to improve patient safety in posthospital medication management for patients with complex care needs. The intervention, involving home visits and an organizing tool, showed promise in enhancing medication management for this vulnerable population.
Area of Science:
- Healthcare management and patient safety research.
- Nursing science and home healthcare delivery.
- Medication management and pharmacovigilance.
Background:
- Increasing numbers of patients with complex care needs are discharged rapidly from hospitals.
- Posthospital medication management is a critical challenge, with up to 94% of medication lists showing discrepancies.
- Visiting nurses play a vital role in managing patient care transitions.
Purpose of the Study:
- To evaluate a novel intervention designed to enhance patient safety in posthospital medication management.
- To assess the effectiveness of a three-element intervention involving interdisciplinary home visits, scheduled follow-ups, and an organizing tool.
- To understand the implementation process and contextual factors influencing medication management by visiting nurses.
Main Methods:
- A process evaluation guided by the UK Medical Research Council's framework was conducted over three months.
- Data collection involved visiting nurses' self-reports on intervention performance and group interviews with 14 nurses.
- Analysis focused on implementation performance, mechanisms of impact, and contextual factors.
Main Results:
- The intervention underscored the significance of the nurse-patient relationship, nursing assessment, logistics, and professional values.
- Patients with complex care needs demonstrated a high implementation rate, with 31 out of 38 patients participating.
- Complex care needs acted as a mediator for successful intervention implementation.
Conclusions:
- Improving posthospital medication management for patients with complex needs requires reconsidering activity-based funding in home healthcare.
- Recognizing the importance of work organization and critically evaluating standard systems are crucial for enhancing care.
- The study offers insights into contextual challenges and methods for future development of posthospital care for complex patients.
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