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Safe medication management in specialized home healthcare: an observational study
KTH Royal Instute of Technology, Sweden;Ersta Sköndal Bräcke University College, Sweden. (SSiHC)
Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden. (SSiHC)
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet, Sweden. (SSiHC)ORCID iD: 0000-0002-4108-391x
2017 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, p. 1-8, article id 598Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Medication management is a complex, error-prone process. The aim of this study was to explore what constitutes the complexity of the medication management process (MMP) in specialized home healthcare and how healthcare professionals handle this complexity. The study is theoretically based in resilience engineering.

METHOD: Data were collected during the MMP at three specialized home healthcare units in Sweden using two strategies: observation of workplaces and shadowing RNs in everyday work, including interviews. Transcribed material was analysed using grounded theory.

RESULTS: The MMP in home healthcare was dynamic and complex with unclear boundaries of responsibilities, inadequate information systems and fluctuating work conditions. Healthcare professionals adapted their everyday clinical work by sharing responsibility and simultaneously being authoritative and preserving patients' active participation, autonomy and integrity. To promote a safe MMP, healthcare professionals constantly re-prioritized goals, handled gaps in communication and information transmission at a distance by creating new bridging solutions. Trade-offs and workarounds were necessary elements, but also posed a threat to patient safety, as these interim solutions were not systematically evaluated or devised learning strategies.

CONCLUSIONS: To manage a safe medication process in home healthcare, healthcare professionals need to adapt to fluctuating conditions and create bridging strategies through multiple parallel activities distributed over time, space and actors. The healthcare professionals' strategies could be integrated in continuous learning, while preserving boundaries of safety, instead of being more or less interim solutions. Patients' and family caregivers' as active partners in the MMP may be an underestimated resource for a resilient home healthcare.

Place, publisher, year, edition, pages
Springer, 2017. Vol. 17, no 1, p. 1-8, article id 598
Keywords [en]
Home healthcare, Medication administration, Medication errors, Medication management process, Patient safety, Resilience
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
URN: urn:nbn:se:lnu:diva-69447DOI: 10.1186/s12913-017-2556-xPubMedID: 28836981Scopus ID: 2-s2.0-85028339124OAI: oai:DiVA.org:lnu-69447DiVA, id: diva2:1316526
Available from: 2019-05-19 Created: 2019-05-19 Last updated: 2019-08-29Bibliographically approved

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