Implementation of Multidose Drug Dispensing in a Home Care Setting: Changes in Safety of Medicines Management

• Main Author: Wekre, Liv Johanne
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: 2014
• Subjects: pasientsikkerhet; legemiddel; legemiddelbruk; multidose; legemiddelhåndtering; legemiddelliste; legemiddelsamstemming; samstemming; legemiddelforskrivning; uhensiktsmessig legemiddelbruk; legemiddelrelaterte problemer; feilmedisinering; allmennmedisin; allmennpraksis; fastlege; lege; sykepleier; helsepersonell; hjemmesykepleie; hjemmeboende; informasjonsutveksling; pasientkommunikasjon; kommunikasjon; rutiner; forskrivningsrutiner; dokumentasjon; elektronisk pasientjournal; pasientjournal; holdninger; erfaringer; fokusgrupper; spørreundersøkelse; journalgranskning; kontrollert studie; intervensjon; eldre; Tromsø; Trondheim; Norge
• Online Access: http://hdl.handle.net/11250/2445183

Doktorgradsavhandling som beskriver studier av kvaliteten og sikkerheten i legemiddelhåndteringen for pasienter i hjemmetjenesten før og etter innføringen av multidose. Multidose dispensed drugs are drugs machine-packed into dose unit bags for each time of administration. Trondheim municipality decided in 2005 to implement Multidose Drug Dispensing (MDD) in home care services. At that time, there was a lack of scientific knowledge about the effects of MDD. The health care management of Trondheim therefore decided to study the implementation in collaboration with NTNU. MDD was adopted gradually during 2006. Three studies were conducted with the common main aim of investigating the safety of medicines management during the implementation of MDD. A complex intervention was designed, including both internal and external controls, and pre-post-examinations. Qualitative as well as quantitative data was gathered, forming a method-, data source-, and observer-triangulation. The introduction of MDD reduced the discrepancies between the medication lists at the general practitioners (GPs), and in the home care services, and even moreso between the GPs and the pharmacies. However, for patients with multidose dispensed drugs, a corresponding improvement also occurred for drugs they received outside the MDD system (e.g. eye drops and inhalers). This finding suggests that new routines, and better collaboration between health practitioners, more than the MDD system by itself, contributed to the improvements. Nevertheless, even if the number of discrepancies between medication lists were reduced, the discrepancies continued to be high, demonstrating that more efforts are needed. Other reported improvements also occurred. Both the general practitioners and the pharmacists reported a better overview of the patients’ medication and thus a better control. The involved health care practitioners also stated an increased trust in each other, as well as in the MDD system, as better collaboration emerged. However, trust in the MDD ...