Browsing by Subject "iäkkäiden lääkehoito"
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(2011)The Ministry of Social Affairs and Health published a report on development needs of elder care and geriatric pharmacotherapy in 2006. The major concern in this report was related to several challenges in pharmacotherapy of the aged, such as deficiencies in medical knowledge of nurses working with elderly people. One way to improve the medication expertise of those various parties involved in caring elderly people is continuing education (CE). The aim of this study was to explore pharmacotherapy-related training needs of health care professionals involved in the home care services for the elderly in the Social and Health Care Cooperation Region of Lohja, Siuntio, Inkoo and Karjalohja (the LOST Region). This study was started by conducting a survey among nurses working in home care services for the elderly in the LOST Region in 2009 (response rate 47%). To deepen understanding of the key findings of the survey, focus group discussions (FGDs) and face-to-face interviews were conducted among nurses, nursing aids, their managers and physicians (1 FGD among nurses, n=6; 1 FGD among their managers, n=6; and face-to-face interviews with 4 physicians). The survey data were analyzed separately for nurses (n=9), practical nurses (n=53) and home aids (n=9), but results were the same in every group. Of the theoretical training needs, topics related to pharmacokinetics and special characteristics of using medicines in the elderly, effects, adverse effects and interactions of medicines, were most important. In addition, the theoretical training needs covered professional ethics issues, such as accuracy and carefulness of nursing practice. The main training needs related to collaborative practice in pharmacotherapy concerned monitoring medicine user's condition and medication, and dosing medicines (right medicine, dose, strength, dosage) in the right time, and administration routes of medicines. Focus group discussions and face-to-face interviews of the physicians provided a deeper understanding of the results of the survey. One of the main findings of this qualitative part of the study was challenges in cooperation in home care services in the LOST Region. Implementation and monitoring geriatric pharmacotherapy can be improved by improving multiprofessional cooperation and training for nurses and physicians working in home care services. The most important diseases and disorders for which the nurses would like to have shared operational guidelines were diabetes, cardiovascular diseases, pain, memory and psychiatric disorders. Training needs also covered special characteristics of pharmacotherapy for the elderly, and formulations and administration routes of medicines. Finally, a synthesis was made of the results of the survey, focus group discussions and face-to-face interviews. On the basis of the synthesis, a proposal for a multiprofessional training was developed for the LOST Region. The training plan includes topics related to geriatric pharmacotherapy and improving collaborative practices and communication as identified by those involved in different stages of the study.
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(2020)Medication-related errors have been identified as the single most important risk factor for patient safety across the world. According to previous research, medication errors are common in nursing homes. However, the existing data on medication errors in Finnish nursing homes is scarce, although the challenges and defects in nursing home care services, including drug treatments, are well known. Furthermore, nursing home residents are typically characterized by old age, multimorbidity and polypharmacy. Therefore, they are particularly vulnerable to potential adverse events caused by medication errors. The aim of this study was to investigate the rates and causes of medication errors reported in nursing homes and evaluate their impact on medication safety. Additionally, the proportions of potentially inappropriate medication (PIMs) and high-risk medication involved in the medication errors were determined. The data of the study consisted of 251 medication errors reports that were submitted to the safety incident report system (HaiPro) in nursing homes located in Central Uusimaa healthcare and social welfare joint municipal authority (Keusote) in 2019. Quantitative analysis of the data provided an overview of the medication errors that had occurred in nursing homes and the medicines most commonly involved in them. Content analysis and simplified root cause analysis enabled to study more in-depth the contributing factors of medication errors and potential risks associated with the medication process in nursing homes, as well as the possibilities of preventing similar errors in the future. James Reason's human error theory and in particular its system perspective was applied as a theoretical framework in this study. Medication errors were reported regularly in nursing homes during the follow-up period of the study. The most frequent medication error type was administration error. The majority of these errors were medication omissions, followed by the wrong time of administration and administration to the wrong patient. The most common drug classes causing medication errors were antithrombotics, opioids, antidementia drugs, diuretics, antipsychotics, antidiabetics, and antidepressants. Nearly a quarter of the reported medicines were high-risk medications, most commonly opioids, antithrombotics, or antidiabetic drugs. PIMs accounted for approximately 13% of all medications in the data. Errors were most often caused by unsafe medication practices, communication problems, and deficiencies in the work environment such as excessive workload or time pressure. A significant part of the medication errors were related to transdermal medication patches. The study also showed that the quality of medication error reporting in nursing homes is in part insufficient and should be improved so that the reports can be better used for learning purposes. The results of the study provide valuable additional information on medication errors in Finnish nursing homes and their contributing factors. The information can be used to improve medication safety practices in nursing homes. Safe and uninterrupted medication use process is a goal that should be pursued not only in health care but also in social welfare services such as nursing homes.
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(2013)Polypharmacy and age-related changes in pharmacodynamics and pharmacocinetics may lead to drug-related problems in elderly patients. Accurate medication reconciliation and medication review on admission may help to control drug-related problems and optimize drug therapy in elderly patients. Several models have been developed to reconciliate and review medications at this point of care. A Finnish model can be developed on the basis of the se models. The aim of this study was to develop a tool for medication reconciliation and medication review on admission for ward pharmacists’ use in the Lahti city hospital. The tool was developed with an action research method in cooperation with the multiprofessional study group. A preliminary tool was developed through doctors’ (n = 2), nurses’ (n = 3) and ward pharmacists’ (n = 2) interviews, a literature review and the expertise of the multiprofessional study group. The preliminary tool was piloted twice in the Lahti city hospital. After the first pilot a view changes were made to the too l by the experiences of the ward pharmacists. Doctors (n = 3) who worked at the study ward during the first pilot were interviewed to find out their views on the medication reconciliation and medication review process so that their views could be taken into consideration in the development of the final version of the tool. After second pilot ward Pharmacists (n = 2), researchers (n = 2) and an expert of geriatrics from the study group took part in a group conversation. Through the group conversation and doctors’ interviews was developed the final version of the tool. The developed tool contains sections for patient’s background information, patient interview, medication reconciliation, drug-related problems, proposed medication changes and doctor’s decisions on the proposed changes. Also instructions of the medication reconciliation and medication review process were developed for ward pharmacists. The developed tool will be used in an intervention study in the Lahti city hospital. In the future a new version of the tool could also be developed to be used in other hospitals in Finland to reconciliate and review medications at the time of hospital admission.
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(2015)Different kind of medication reviews have been developed in different countries. In Finland comprehensive medication review was developed in the late 2000th. Only few researches of medication review exist in Finland. In other countries more studies on the subject have been done. This Master's thesis's aim in the literature review was to examine what kind of outcome measurements were used in medication review studies and what kind of results were obtained from these measurements. In many medication review studies different kind of drug related parameters were used to evaluate the effectiveness of medication review. These parameters are Drug Related Problems (DRP), Medication Appropriateness Index (MAI) and different kind of criteria's for potentially inappropriate medication for elderly. Medication reviews have showed a positive effect on these parameters. To the health-related quality of life medication reviews have not shown any statistical effect. Physical performance meters have not been used a lot in medication review studies. And results have been controversial. Omahoitosuunnitelma 2100 (OMA21) research project, that examines the effectiveness of the comprehensive medication review in Finnish health care, could potentially due to its long follow-up time produce results also from the quality of life and physical performance instruments. In the Master's thesis's experimental part the aim was to evaluate unity of the medication reviews in OMA21 research project. For four intervention patients in the OMA21 research project parallel medication reviews were done. From these reviews were examined how many of the problems found in the reviews were the same with different reviewers. There was a lot of dispersion in the problems found in the reviews. Only 17.5 % of the 40 different problems found in the reviews were the same with all the reviewers. From 12 patients medication reviews drug related problems were categorized by PCNE classification V6.2. 69 drug related problems were found from the medication reviews. Most common problem was the treatment effectiveness (P1) (37.7 %). For the problems 92 potential causes were found and the most common of them was drug selection (C1) (39.1 %). The aim was also examine whether Evidence-Based Medicine electronic Decision Support (EBMeDS) tool, developed by Duodecim Medical Publications Ltd, could be useful in the OMA21 research project. It was shown that EBMeDS have limited advantage if patients' information has not been reported right in the electronic health records. Only 30 % of the examined drugs had indication. In the future if the patients' information was reported right in the electronic health records the EBMeDS tools could be useful help in medication reviews, because EBMeDS contains many electronic databases that are often used in medication reviews.P50O48
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(2020)Iäkkäiden määrän lisääntyminen aiheuttaa tarpeen kehittää ja tutkia uusia lääkkeitä sekä lääkemuotoja entistä enemmän. Iän tuomat fysiologiset muutokset sekä useat sairaudet voivat aiheuttaa ongelmia perinteisten lääkkeiden annostelussa. Annosteluongelmien ratkaiseminen lääkemuodon muokkaamisella voi kuitenkin aiheuttaa riskin lääkitysturvallisuudelle. Tämän pro gradu -tutkielman tarkoituksena oli tutkia iäkkäitä potilaita hoitavien lääkäreiden kohtaamia lääkemuotoihin liittyviä ongelmia. Tutkimuksen avulla pyrittiin selvittämään, kohtaavatko lääkärit hoitotyössä lääkemuotojen aiheuttamia ongelmia, ja minkälaisia ongelmia lääkärit kohtaavat. Lisäksi lääkäreiden haastatteluissa esiinnousseita teemoja verrattiin hoitajien kolmen päivän seurantajakson aikana verkkokyselylomakkeelle kirjaamiin lääkemuotoihin liittyviin käytännön ongelmiin, joita käytännön hoitotyössä palveluasumisen yksiköissä ilmeni aiemmin toteutetussa tutkimuksessa. Tutkimuksessa haastateltiin viittä lääkäriä, joilla oli kokemusta iäkkäiden lääkehoidosta. Lääkärit etsittiin tutkimukseen mukaan sosiaalisen median kautta hakuilmoituksella. Puolistrukturoidut haastattelut nauhoitettiin ja litteroinnin jälkeen niiden analysoinnissa käytettiin aineistolähtöistä sisällönanalyysiä. Tabletteihin liittyviksi ongelmiksi lääkärit mainitsivat niiden ison koon ja pintaominaisuudet, joiden vuoksi niiden nieleminen vaikeutuu. Muita ongelmia olivat tablettien tunnistettavuus, jakouurteen puute sekä sopivien vahvuuksien puute, vaikkakin yleisesti lääkäreiden mielestä eri vahvuuksia on tarpeeksi markkinoilla. Kapseleiden ongelmiksi lääkärit mainitsivat myös ison koon sekä epäselvyyden siitä, saako kapselia avata vai ei. Oraaliliuosten ongelmiksi koettiin paha maku, liian laimeat vahvuudet, lasku- ja mittaamisvirheen riski sekä sekaantumisen vaara. Lääkelaastarit jakoivat mielipiteitä, mutta niiden ongelmiksi lueteltiin muun muassa iho-oireet ja laastarin irtoaminen. Yleisesti lääkärit eivät olleet tablettien murskaamisen kannalla, mutta jokainen haastatelluista lääkäreistä totesi murskaamisen olevan joissakin tilanteissa ainoa vaihtoehto. Lisäksi lääkärit luettelivat useita lääkemuotoihin liittymättömiä ongelmia, jotka liittyivät sekä potilaaseen mutta myös terveydenhuoltojärjestelmään. Jotta lääkemuotoihin liittyviä ongelmia voitaisiin vähentää, tulisi iäkkäiden kohdalla aina arvioida lääkehoito säännöllisesti. Arvioinnin perusteella iäkkäälle voitaisiin valita hänelle parhaiten sopivat lääkemuodot ja huolehtia siitä, ettei tarpeettomia valmisteita ole käytössä. Lääketeollisuuden ja lääkeviranomaisten vastuulla on edistää lääkkeiden kehitystä ja uusien innovaatioiden tuomista markkinoille. Käytännössä lääketeollisuus voi helpottaa terveydenhuollon ammattilaisten työtä tuottamalla selkeitä lääkeinformaatiotekstejä, joilla voisi esimerkiksi helpottaa murskaamispäätöksen tekemistä.
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(2023)Väestön ikääntyessä sairastavuus lisääntyy ja käytettyjen lääkkeiden määrä kasvaa altistaen lääkkeiden haitta- ja yhteisvaikutuksille. Iäkkäiden suuri sairastavuus, monilääkitys ja lääkkeiden aiheuttamat haitat voivat kasaantuessaan huonontaa elämänlaatua ja toimintakykyä. Lääkehoidon arviointien avulla voidaan tunnistaa ja ratkaista monilääkittyjen iäkkäiden lääkitysongelmia. Jos potilaan lääkehoidon kokonaisuutta ei arvioida säännöllisesti, lääkkeitä voidaan määrätä lisää perusteettomasti, mikä voi johtaa lääkkeiden kasautumiseen ja estettävissä olevien haittojen lisääntymiseen. Tämän tutkimuksen aineisto perustuu Lohjan kaupungin kotihoidossa vuosina 2015-2017 toteutettuun interventiotutkimukseen. Tämän tutkimuksen tavoitteena oli analysoida pseudonymisoiduissa lääkehoidon arviointiraporteissa (n=43) tunnistettuja lääkitysongelmia (drug-related problems, DRPs) 65 vuotta täyttäneillä PCNE-luokittelujärjestelmän avulla. Lisäksi tavoitteena oli tarkistaa erilaisten lääkehoidon tietokantojen ja työkalujen avulla olivatko farmasistien muutosehdotukset ja huomiot valideja ja hoitosuositusten mukaisia. Lisäksi tutkittiin, mihin ATC- pääryhmiin ja edelleen lääkeaineisiin muutosehdotukset kohdistuivat sekä miten ne toteutuivat. Muutosehdotuksille ja huomioille (n=167) yleisimmin koodattu PCNE-luokituksen mukainen ongelma (P) oli P2.1 “Lääkkeen haittatapahtuma (mahdollinen)” (65,3 % n=109). Yleisin koodattu syy (C) oli C1.1 “Epätarkoituksenmukainen lääke suhteessa suosituksiin” (34,1 %). Ehdotuksista toteutui seurannassa 37,7 % (n=63), joissa yleisimmät interventiot olivat I3.5 ”Lääkkeen lopetus tai tauotus” (n=27) ja I3.2 ”Annosmuutos” (n=23). Yleisimmin muutosehdotukset ja huomiot kohdistuivat hermostoon vaikuttaviin lääkkeisiin (43,7 %), ruuansulatuselinten sairauksien ja aineenvaihduntasairauksien lääkkeisiin (26,3 %) ja sydän- ja verisuonisairauksien lääkkeisiin (15,0 %). Muutosehdotuksista ja huomioista 37,1 % (n=62) liittyi Fimean Lääke 75+ -tietokannan mukaan iäkkäille varauksin soveltuviin (ns. C-luokka) ja 23,9 % (n=41) iäkkäillä vältettäviin lääkeaineisiin (ns. D-luokka). C-luokan lääkeaineisiin liittyneistä ehdotuksista toteutui 27,4 % ja D-luokan lääkeaineisiin liittyneistä ehdotuksista toteutui 37,5 %. Farmasistin muutosehdotuksista ja huomioista valideja oli 98,2 % (n=164/167). Farmasistien osaamista tulisikin hyödyntää enemmän lääkitysongelmien ratkomisessa, mikä tukisi lääkärien sekä muiden sosiaali- ja terveydenhuollon ammattilaisten työtä.
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