Introduction
Medication errors are some of the factors contributing significantly to poor patient outcomes, such as morbidity and mortality. This problem is compounded further when patients are required to self-medicate once discharged from the hospital. Therefore, there is an overarching need to address this problem for improved patient outcomes. This paper is an annotated bibliography using 15 scholarly sources on medication safety and reconciliation in a homecare setting after discharge from the hospital, as the research problem. The selected articles discuss evidence-based best practices, quality indicators, a means of validating assumptions, and successful interventions when addressing the aforementioned clinical problem.
Annotated Bibliography
Berland, A., & Bentsen, S. B. (2017). Medication errors in-home care: A qualitative focus group study. Journal of Clinical Nursing, 26(21-22), 3734-3741.
This exploratory qualitative design study addresses registered nurses’ experiences concerning medication safety among patients in a home care setup. Four focus groups were whereby data was collected through interviews and analyzed using content analysis. The results showed that medication errors among registered nurses in primary care settings occur mainly due to reporting inconsistencies, lack of competence, lack of information, trade name products, and varying routines. Therefore, the article proposes that there should be effective communication among caregivers based on up-to-date information coupled with having competent nurses together with open and accurate reporting of medication errors. In addition, there should be clear routines for preparing, changing, and administering medicines.
Champion, C., Sockolow, P. S., Bowles, K. H., Potashnik, S., Yang, Y., Pankok Jr, C., Le, N., McLaurin, E., & Bass, E. J. (2020). Getting to complete and accurate medication lists during the transition to home health care. Journal of the American Medical Directors Association, 4, 1-6.
This paper sought to characterize the nature of work done by nurses during home health care (HHC) admission, which is mainly part of medication reconciliation tasks. It also explores the effect of the interoperability of electronic medication data on enhancing medication reconciliation. The results found that poly-pharmacy is a major problem among home-based patients, with some taking more than 12 medications concurrently. However, reconciliation reduced the number of medications significantly. It was also noted that the availability of interoperable systems reduces poly-pharmacy significantly, and thus it could be used as an essential nursing tool for improved reconciliation when transitioning from hospital to home-based care.
Elliott, R. A., Lee, C. Y., Beanland, C., Vakil, K., & Goeman, D. (2016). Medicines management, medication errors and adverse medication events in older people referred to a community nursing service: A retrospective observational study. Drugs-Real World Outcomes, 3(1), 13-24.
In this retrospective observational study, the authors explored how older people in home-based care receive medicine support from hospitals and other community nursing services (CNSs). A sample of 100 older people under a home-care setting was recruited for this stud, which ran for three months. The result showed several medicine misadventures among older people receiving home-based care. For instance, medication errors occurred in 41 percent of the participants leading to preventable hospitalization. The major contributing factors to this problem were the low usage of medication charts and the lack of interdisciplinary medication review. Therefore, there is a need to create strategies to improve medication management in home-based care set-ups.
Flanagan, P. S., Briseño-Garzón, A., Zed, P. J., & Strain, R. M. (2018). Safety outcomes with home assessment trial: A mixed-methods evaluation of medication safety in the home care setting. Home Health Care Management & Practice, 30(2), 76-82.
The purpose of this study was to evaluate the feasibility of using prospective evaluation to prevent medication errors among home-based patients to inform future research on the topic. 19 patients undergoing primary care were recruited for the study, which took over 21 months, and all reported one or more cases of adverse drug events. The common problems included a lack of sufficient knowledge concerning drugs, poor communication, and insufficient human resources. Therefore, medication safety among patients under home-based care could be achieved by conducting thorough patient education before discharge and improving follow-up communication as part of patient support after discharge.
Foged, S., Nørholm, V., Andersen, O., & Petersen, H. V. (2018). Nurses’ perspectives on how an e‐message system supports cross‐sectoral communication in relation to medication administration: A qualitative study. Journal of Clinical Nursing, 27(3-4), 795-806.
According to this article, the medication process is complex and thus it should be handled carefully to avoid preventable errors, which could be costly. Therefore, the authors wanted to understand the role of e-messaging as part of communication between secondary and primary care nurses, specifically in relation to the administration of medicine. The results indicated that while e-messaging has the potential to improve communication between nurses, it fails at this objective due to inherent limitations of the system, lack of knowledge of primary care among hospital-based nurses, and lack of access to medication information. E-messaging could play a major role in facilitating effective communication between the hospital and home-based care nurses.
Hale, J., Neal, E. B., Myers, A., Wright, K. H., Triplett, J., Brown, L. B.,… & Mixon, A. S. (2015). Medication discrepancies and associated risk factors identified in home health patients. Home Healthcare Now, 33(9), 493-499.
This article’s objective was to assess the type, frequency, and reason for medication errors among patients receiving care at home after discharge from a hospital. To establish medication discrepancy, the authors compared the list of medication given during discharge and what the patients were taking from their homes. 94 percent of the participants reported at least one case of medication discrepancy, with the majority of them being associated with omission errors. Patients were simply not taking all the medications on the discharge list. The major problem associated with this issue was a lack of enough understanding by patients concerning medication; hence, the need for patient education before discharge.
Jones, C. D., Jones, J., Richard, A., Bowles, K., Lahoff, D., Boxer, R. S., Masoudi, A., Coleman, E., & Wald, H. L. (2017). “Connecting the dots”: A qualitative study of home health nurse perspectives on coordinating care for recently discharged patients. Journal of General Internal Medicine, 32(10), 1114-1121.
The authors of this qualitative article sought to describe the experiences of home health care nurses regarding challenges and solutions to managing care for discharged patients. Nearly 75 percent of people aged over 65 years are referred to HHC upon discharge from hospitals. Therefore, the level of coordination between hospitals and HHC nurses plays a major role in ensuring medication safety and reconciliation during this period of transition. The main challenges faced by HHC nurses, which contribute significantly to medication errors include lack of accountability, poor communication, inadequate assessment of goals, and poor management of medications. These domain areas could be addressed to improve safety and care outcomes.
Kee, K. W., Char, C. W. T., & Yip, A. Y. F. (2018). A review on interventions to reduce medication discrepancies or errors in primary or ambulatory care settings during care transition from hospital to primary care. Journal of Family Medicine and Primary Care, 7(3), 501-506.
According to the authors of this article, the probability of medication errors increases significantly during the transition from hospitals to home-based care. The objective of this review was to highlight intervention measures to reduce medication errors and discrepancies in primary care during discharge from hospitals. The key players involved in this process are pharmacists, nurses, and primary care physicians. The noted intervention measures were effective communication among the involved parties, thorough medication reconciliation, and detailed clarification of medication-related problems once they arise. These strategies could be employed to improve patient outcomes by reducing medication errors after discharge.
Meyer-Massetti, C., Hofstetter, V., Hedinger-Grogg, B., Meier, C. R., & Guglielmo, B. J. (2018). Medication-related problems during the transfer from hospital to home care: Baseline data from Switzerland. International Journal of Clinical Pharmacy, 40(6), 1614-1620.
This article sought to evaluate the various medication-related problems experienced when discharging patients from hospitals and transferring them to home-based care. The study had 100 patients aged over 64 years receiving at least 4 medications at the time of discharge. The main problems associated with medication errors included lack of information concerning the medicines and unclear discharge medication prescriptions. The problems could be grouped into three – poor quality of prescription, unreliable medication availability, and poor communication. Consequently, addressing these areas could improve patient safety significantly by reducing medication errors.
Meyer-Massetti, C., Meier, C. R., & Guglielmo, B. J. (2018). The scope of drug-related problems in the home care setting. International Journal of Clinical Pharmacy, 40(2), 325-334.
In this article, the authors argue that while the scope of adverse drug events is extensively studied with hospital set-ups, information about their scope in primary care is limited. Therefore, the article’s objective was to evaluate the incidences and nature of drug-related problems in a primary care setting and recommend corrective measures. The commonly identified problems associated with medication errors in the available literature include potentially inappropriate medications, outright medication errors during administration, and polypharmacy. The lack of effective communication and enough patient information also contributed to this problem. Therefore, during discharge, there should be comprehensive communication among the interdisciplinary teams involved in the process with patients and caregivers becoming partners to address medication errors.
Mickelson, R. S., & Holden, R. J. (2018). Medication adherence: Staying within the boundaries of safety. Ergonomics, 61(1), 82-103.
The authors of this article applied ergonomics methods and theories to evaluate the boundaries of patient safety among home-based patients within the selected area of study. Specifically, the authors focused on human factors that contribute to adherence to drugs. The problem of non-adherence to medications was divided into two – errors and violations. Factors shaping this issue included patient limitations, task complexity, the quality of tools used, organizational, and social contexts. Ultimately, the authors created a dynamic systems model that could be applied to ensure that patients stay within the boundaries of safety when using drugs after being discharged from hospitals.
Olsen, R. M., & Sletvold, H. (2018). Potential drug-to-drug interactions: a cross-sectional study among older patients discharged from hospital to home care. Safety in Health, 4(8), 1-8.
This article’s objective was to identify potential medication errors among older people after being discharged from hospitals and highlight some of the characteristics that contribute to these errors. The main issues contributing to this problem included age, standards of living, and the prescribed drugs. Therefore, the study concluded that monitoring for potential medication errors, especially drug-to-drug interactions would play a central role in preventing such incidences.
Parand, A., Garfield, S., Vincent, C., & Franklin, B. D. (2016). Carers’ medication administration errors in the domiciliary setting: A systematic review. PloS One, 11(12), 1-18.
The aim of this article was to review studies on how primary caregivers prevent medication errors among home-based patients after discharge from the hospital. The focus was to identify the type, prevalence, and causes of the medication errors with the objective of identifying evidence-based intervention measures. The main errors were omitted or wrong administration, wrong time or route of administration, and dosage errors. The most effective evidence-based intervention measures to prevent medication errors were training caregivers on how to handle drugs and availing tailored equipment based on the case being addressed.
Sarzynski, E., Ensberg, M., Parkinson, A., Fitzpatrick, L., Houdeshell, L., Given, C., & Brooks, K. (2019). Eliciting nurses’ perspectives to improve health information exchange between hospital and home health care. Geriatric Nursing, 40(3), 277-283.
The authors of this article argued that the available research fails to seek feedback from nurses concerning health information exchange. Therefore, this article sought to address this problem by identifying opportunities that could be exploited to facilitate the effective transfer of information when transitioning from hospital to home-based care. The main problems that hinder the transfer of information as noted by the participating nurses include poor medication management, poor communication, patient factors, and technological issues. Therefore, addressing these areas could improve information transfer and prevent avoidable medication errors. Additionally, involving nurses when adopting technology would go a long way in solving this problem.
Zurlo, A., & Zuliani, G. (2018). Management of care transition and hospital discharge. Aging Clinical and Experimental Research, 30(3), 263-270.
According to this article, the lack of proper discharge planning affects the transition from hospital to home-based care, which ultimately contributes to high readmission rates due to medication errors among other related issues. Therefore, it is imperative for the hospital to consider some of the pertinent issues during discharge. Some of the aspects include a comprehensive assessment of care conditions, understanding the patient’s expectations, thorough knowledge of transitional care programs, and strong communication between hospitals and home care settings. These elements would contribute significantly to the avoidance of problems, such as medication errors, for improved patient and care outcomes.
Conclusion
This annotated bibliography has shown that the problem of medication errors is common during the transition from hospital to home-based care. Some of the articles used have outlined measures that could be implemented to improve patient safety after discharge. The information gathered from this annotated bibliography will play a central role in the current project, which is concerned with medication safety and reconciliation in the homecare setting after discharge from the hospital.