Browsing by Author "Toivonen, Laura"

Abstract Faculty: Faculty of Pharmacy Degree programme: Master of Science in Pharmacy Study track: Social pharmacy Author: Laura Toivonen Title: Deficiencies and risks related to medication use management in nursing homes identified by Regional State Administrative Agencies during their inspection visits Level: Master´s thesis Month and year: November 2021 Number of pages: 94+7 (appendice) Keywords: Medication safety, medication use process, nursing home, older adult, risk management, guidelines for safe medication practices Supervisor or supervisors: M.Sc. Pharm, PhD student Suvi Hakoinen, University of Helsinki, Keusote; Professor, PhD Marja Airaksinen, University of Helsinki Where deposited: ethesis.helsinki.fi Additional information: Abstract: Nursing home residents are often characterized by older age, multimorbidity and polypharmacy. Medication safety has become an issue as part of client/patient safety in nursing homes in Finland. Still, little is known about medication safety risks and their management in this care context. The aim of this study was to identify deficiencies and risks associated with medication use management in nursing homes using inspection visits by the Regional State Administrative Agencies (AVIs) as a data source. In addition, the aim was to evaluate what issues the AVI-authorities pay attention to in the medication use management during their inspection visits in nursing homes. The data consisted of the latest inspection reports (n = 24) prepared by the Regional State Administrative Agencies (n = 6) on the basis of their nursing home visits (nursing homes for older people). The data were analysed by deductive content analysis methods. In addition to qualitative documentary analysis, quantitative indicators were used to illustrate the frequency of the risks and deficiencies -observed in different phases in the medication use process to identify phases posing risks most commonly. Reason´s system-based risk management theory was applied as a theoretical framework for the study. A total of 372 deficiencies and risks related to medication use process were identified from the inspection reports (n = 24) of Regional State Administrative Agencies. The largest proportion (58,9 %, n = 219) of the deficiencies and risks concerned the management and quality management of the medication use process. Particularly, deficiencies and risks related to lack and competence of personnel were emphasized. Deficiencies and risks were also identified in the self- assessment guidelines for safe medication practices used in the inspected nursing homes. The second highest number of risk observations (26,9 %, n = 100) was reported for ordering, delivery and storage of medicines. In particular, the deficiencies and risks were reported for the storage and warehousing practices. Reported risk observations in other phases of the medicines use process were rare. This study showed that the medication use process in Finnish nursing homes includes deficiencies and risks endangering the safety of the older nursing home residents. In order to manage the risks, both self-assessment and inspection practices by the authorities need development. One way to improve and harmonize both self-assessment and inspection practices could be use of a comprehensive checklist covering of all the relevant issues required for the safe medication practices in nursing homes. Increasing collaboration with pharmacists could also be a way to improve medication safety in nursing homes.