Browsing by Subject "havainnointi"

In Finland, an increasing number of older adults who need around-the-clock assistance in their daily activities are taken care of in an intensive service housing unit, i.e., in a nursing home. The care organized in a nursing home also includes the resident's medical treatment and care. Medication safety and medication management processes have been widely studied in healthcare units, but there is a lack of similar research data from social care units. The topic is current because problems have arisen within the medication management process of the nursing homes, to which system-oriented solutions are needed. To develop risk management, additional information is needed on the risk points occurring in the medication management process of nursing homes. The study aimed to produce information on what kind of medication errors can be detected in the practical implementation of medication in a nursing home and in which stages of the medication management process they occur. The study was based on participatory observation data collected in a nursing home. The data was analyzed using quantitative and qualitative content analysis methods. The study’s theoretical framework was James Reason's human error theory and the Swiss cheese model. It was found that medication errors were common in the observed nursing home, as almost every fourth observed situation contained at least one medication error. Medication errors were detected at almost every stage of the medication management process. Storage errors (28 %) and medication administration errors (19 %) were detected more often than other types of errors. Detected storage errors were mostly related to not locking the medicine storage facilities or leaving medicines without monitoring. The most frequent administration error was medication omission. After storage and administration errors, the most commonly detected medication error types were error in cleaning or tidiness (7 %), ordering error (7 %) and error in medication administration checks (6 %). Other types of medication errors represented less than 5 % of the data. Almost a quarter of the errors were found to have happened to the resident, causing a medication safety incident. Actual adverse events could not be identified based on the data. About a fifth of the errors were near misses. Although about half of the errors did not happen directly to the residents, they were identified as medication, client, and patient safety risks. Pharmaceutical information was found to function as a good barrier in the medication management process, as some of the possible adverse events were prevented with the help of medical advice given to nurses. The medication management process of nursing homes could be developed by considering unit-specific risk factors and utilizing pharmaceutical expertise in the implementation of medical treatment. Through observation, it would also be possible to identify contributing factors of medication errors, enabling risk management activities to be targeted at the risk points of the medication management process. The study results offer valuable information about medication errors in nursing homes, which can be used in developing the medication management process.