591719 research-article2015
SJP0010.1177/1403494815591719M Dimitrow et al.Feasibility of a practical nurse administered risk assessment tool
Scandinavian Journal of Public Health, 2015; 43: 761–769
Original Article
Feasibility of a practical nurse administered risk assessment tool for drug-related problems in home care
Maarit s Dimitrow1, saija n Leikola1, sirkka-liisa kivelä1,2, sanna Passi3, pirjo lukkari4 & marja sa airaksinen1 1Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland, 2Institute of Clinical Medicine, Department of Family Medicine, University of Turku, Unit of Family Medicine, Turku University Hospital and Satakunta Hospital District, Finland, 3Palmenia Centre for Continuing Education, University of Helsinki, Finland, and 4The Finnish Union of Practical Nurses, Finland
Abstract Aim: To evaluate feasibility of a practical nurse-administered Drug-related Problem Risk Assessment Tool among home care clients ⩾65 years. Methods: Altogether, 36 practical nurses participated in the study. They were trained about the purpose and use of the tool. The training consisted of a day long interactive workshop and involved reviewing four self-selected clients’ medications using the tool (one as a pre-assignment before and three as post-assignments after the workshop). The data of this study were collected during the training. Triangulation, i.e. combination of methods and data, was used to evaluate the feasibility of the tool. Quantitative data were gathered from returned post-assignment tools and qualitative data from face-to-face discussions and open questions in feedback forms the practical nurses returned after the training. Results: Practical nurses spent 10–45 minutes reviewing one client’s medication using the tool (mean 20±8). They identified reliably 88% of the risk medicines used by the clients listed in the tool. Of the respondents (n=23) of the feedback forms, 43% reported that they felt it easy or quite easy to answer the questions of the tool. Generic names of medicines, time constraints, home-care workers’/client’s lack of interest to client’s pharmacotherapy and short client contacts were the most common barriers to use the tool. Conclusions: The Drug-Related Problem Risk Assessment Tool turned out to be feasible among practical nurses. The brief training on the content and use of the tool seems to be sufficient for ensuring reliable use of the tool. Key Words: Assessment, client, drug-related problem, feasibility, home care, practical nurse, risk, tool
Introduction The demand for long-term home health care services for the aged is increasing due to demographic and societal developments [1]. Aged people needing home care (HC) are increasingly older, have many chronic diseases and use multiple medicines and thus, are at high risk for drug-related problems (DRPs) [1–3]. As DRPs have been associated with increased morbidity, mortality and healthcare resource utilisation among the aged, strategies to detect and prevent DRPs are urgently needed [4,5].
Practical nurses (PNs) are those who most often visit the aged using HC services and are in a key position to monitor the risks and benefits of medication. In Finland, they have 3-year vocational education that concentrates mainly on supportive and technical nursing rather than pharmacotherapy [6]. However, in their daily work with the home-dwelling aged clients, the PNs should be able to monitor the risks and benefits related to their clients’ pharmacotherapy and discuss their observations in multidisciplinary
Correspondence: Maarit S. Dimitrow, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Teipparintie 12 B, 48810 Kotka, Finland. E-mail: [email protected] (Accepted 24 May 2015) © 2015 the Nordic Societies of Public Health DOI: 10.1177/1403494815591719
Downloaded from sjp.sagepub.com at CMU Libraries - library.cmich.edu on October 22, 2015
762 M Dimitrow et al. Table I. Drug-related Problem (DRP) Risk Assessment Tool [10]. Basic client data Name Identity number Age, years Gender: male female Does the client live alone? Does the client have an up-to-date medication card/list? Who administers the client’s medicines? Potential risks for DRPs in medication use (answering options: ‘yes’ or ‘no’, or select appropriate item(s)) 1. Does the client have seven or more prescription medicines in current regular use? (excluding basic creams) 2. Does the client take 12 or more medicine doses regularly each day (excluding basic creams)? Example of counting the doses: drug 1: 1 tablet 3 times per day = 3 doses; drug 2: 1 dose 2 times per day = 2 doses; i.e. in total 5 doses per day 3. Is the client currently taking medicines for three or more diseases or symptoms? (including acute diseases) 4. Has the client started a new medicine in the last 4 weeks? (excluding different brands of the same active ingredient) 5. Does the client use medicines that: (a) relieve pain by reducing inflammation (does not apply to paracetamol)? (b) elevate the rate of urination (diuretics)? (c) are intended to lower the cholesterol level (statins)? (d) the physician does not know about? 6. Does the client use any of the following medicines (the list contains medicines with a narrow therapeutic index, medicines for which regular monitoring would be necessary and medicines that otherwise are problematic for the aged) (please check the ones used)? amiodarone, lithium, carbamazepine, methotrexate, digoxin, theophylline, fluoxetine, warfarin 7. Has the client used over-the-counter medicines or vitamin, mineral or herbal products in the past 2 weeks? State which ones 8. Has the client had any of the following symptoms in the last 4 weeks? (Please tick below ‘yes’ if it has been ongoing and add another tick in the right column if the symptom is a new one = a symptom that had first occurred within the last 4 weeks), drowsiness, fatigue, skin rash or itch, dizziness, urination problems, muscle pains, nausea, diarrhoea, constipation, dizziness when getting up, recurrent falls, swellings, memory problems, confusion, visual problems, stiffness, troubles in walking, low blood pressure, systolic
SJP0010.1177/1403494815591719M Dimitrow et al.Feasibility of a practical nurse administered risk assessment tool
Scandinavian Journal of Public Health, 2015; 43: 761–769
Original Article
Feasibility of a practical nurse administered risk assessment tool for drug-related problems in home care
Maarit s Dimitrow1, saija n Leikola1, sirkka-liisa kivelä1,2, sanna Passi3, pirjo lukkari4 & marja sa airaksinen1 1Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland, 2Institute of Clinical Medicine, Department of Family Medicine, University of Turku, Unit of Family Medicine, Turku University Hospital and Satakunta Hospital District, Finland, 3Palmenia Centre for Continuing Education, University of Helsinki, Finland, and 4The Finnish Union of Practical Nurses, Finland
Abstract Aim: To evaluate feasibility of a practical nurse-administered Drug-related Problem Risk Assessment Tool among home care clients ⩾65 years. Methods: Altogether, 36 practical nurses participated in the study. They were trained about the purpose and use of the tool. The training consisted of a day long interactive workshop and involved reviewing four self-selected clients’ medications using the tool (one as a pre-assignment before and three as post-assignments after the workshop). The data of this study were collected during the training. Triangulation, i.e. combination of methods and data, was used to evaluate the feasibility of the tool. Quantitative data were gathered from returned post-assignment tools and qualitative data from face-to-face discussions and open questions in feedback forms the practical nurses returned after the training. Results: Practical nurses spent 10–45 minutes reviewing one client’s medication using the tool (mean 20±8). They identified reliably 88% of the risk medicines used by the clients listed in the tool. Of the respondents (n=23) of the feedback forms, 43% reported that they felt it easy or quite easy to answer the questions of the tool. Generic names of medicines, time constraints, home-care workers’/client’s lack of interest to client’s pharmacotherapy and short client contacts were the most common barriers to use the tool. Conclusions: The Drug-Related Problem Risk Assessment Tool turned out to be feasible among practical nurses. The brief training on the content and use of the tool seems to be sufficient for ensuring reliable use of the tool. Key Words: Assessment, client, drug-related problem, feasibility, home care, practical nurse, risk, tool
Introduction The demand for long-term home health care services for the aged is increasing due to demographic and societal developments [1]. Aged people needing home care (HC) are increasingly older, have many chronic diseases and use multiple medicines and thus, are at high risk for drug-related problems (DRPs) [1–3]. As DRPs have been associated with increased morbidity, mortality and healthcare resource utilisation among the aged, strategies to detect and prevent DRPs are urgently needed [4,5].
Practical nurses (PNs) are those who most often visit the aged using HC services and are in a key position to monitor the risks and benefits of medication. In Finland, they have 3-year vocational education that concentrates mainly on supportive and technical nursing rather than pharmacotherapy [6]. However, in their daily work with the home-dwelling aged clients, the PNs should be able to monitor the risks and benefits related to their clients’ pharmacotherapy and discuss their observations in multidisciplinary
Correspondence: Maarit S. Dimitrow, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Teipparintie 12 B, 48810 Kotka, Finland. E-mail: [email protected] (Accepted 24 May 2015) © 2015 the Nordic Societies of Public Health DOI: 10.1177/1403494815591719
Downloaded from sjp.sagepub.com at CMU Libraries - library.cmich.edu on October 22, 2015
762 M Dimitrow et al. Table I. Drug-related Problem (DRP) Risk Assessment Tool [10]. Basic client data Name Identity number Age, years Gender: male female Does the client live alone? Does the client have an up-to-date medication card/list? Who administers the client’s medicines? Potential risks for DRPs in medication use (answering options: ‘yes’ or ‘no’, or select appropriate item(s)) 1. Does the client have seven or more prescription medicines in current regular use? (excluding basic creams) 2. Does the client take 12 or more medicine doses regularly each day (excluding basic creams)? Example of counting the doses: drug 1: 1 tablet 3 times per day = 3 doses; drug 2: 1 dose 2 times per day = 2 doses; i.e. in total 5 doses per day 3. Is the client currently taking medicines for three or more diseases or symptoms? (including acute diseases) 4. Has the client started a new medicine in the last 4 weeks? (excluding different brands of the same active ingredient) 5. Does the client use medicines that: (a) relieve pain by reducing inflammation (does not apply to paracetamol)? (b) elevate the rate of urination (diuretics)? (c) are intended to lower the cholesterol level (statins)? (d) the physician does not know about? 6. Does the client use any of the following medicines (the list contains medicines with a narrow therapeutic index, medicines for which regular monitoring would be necessary and medicines that otherwise are problematic for the aged) (please check the ones used)? amiodarone, lithium, carbamazepine, methotrexate, digoxin, theophylline, fluoxetine, warfarin 7. Has the client used over-the-counter medicines or vitamin, mineral or herbal products in the past 2 weeks? State which ones 8. Has the client had any of the following symptoms in the last 4 weeks? (Please tick below ‘yes’ if it has been ongoing and add another tick in the right column if the symptom is a new one = a symptom that had first occurred within the last 4 weeks), drowsiness, fatigue, skin rash or itch, dizziness, urination problems, muscle pains, nausea, diarrhoea, constipation, dizziness when getting up, recurrent falls, swellings, memory problems, confusion, visual problems, stiffness, troubles in walking, low blood pressure, systolic
