ORCID Profile
0000-0002-4660-1667
Current Organisation
The University of Auckland
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Publisher: Wiley
Date: 10-06-2021
DOI: 10.1111/OPN.12393
Abstract: This study aimed to explore the experiences and perceptions of nursing home staff and residents of unauthorised covert administration of medication. Prior studies identify that covert medication administration (crushing medication to administer in food or drink) is common in nursing home settings. Still, few recognise that this practice may occur without consultation or clinical authorisation. An exploratory qualitative study was conducted with nursing home staff and residents as part of a more extensive mixed‐methods study on medication omissions and clinical decision‐making. We conducted a qualitative study using focus groups and semi‐structured interviews across four geographical areas in New Zealand to better understand nursing home staff and residents' experiences and perspectives on covert administration. Semi‐structured interviews took place with 11 Clinical managers/leads and one senior Registered Nurse role specific focus groups were held with Registered Nurses ( n = 6), Health Care Assistants ( n = 14), and Residents ( n = 12). Data were analysed using thematic analysis. Participants described covert administration as a practical option if a nursing home resident refused medication but recognised it was a deception that carried ethical and clinical risks, particularly when unauthorised. Participants felt that unauthorised covert administration stemmed from doubts about residents' competence and the competing demands staff face during medication administration. Staff, who typically relied on advice from their pharmacies around which medications were safe to crush, expressed a need for more education. This study provides evidence that unauthorised covert administration of medications is an ongoing practice, using New Zealand nursing homes as an ex le. The results emphasise that nursing home staff and residents are aware that this practice carries ethical and clinical risks and requires a certified process to legitimise its authorised form.
Publisher: Wiley
Date: 22-06-2020
DOI: 10.1111/AJAG.12812
Abstract: To investigate the dispensing, administration and omission of medications in residential aged care (RAC) homes in New Zealand (NZ). Secondary data from a medication management database were analysed, to identify the most frequently omitted regular medications and commonly reported reasons for omissions in a s le of 11 015 residents across 374 RAC homes. Overall, 3.59 medication doses were omitted per 100 (±7.4) prescribed doses per resident (SD 7.43). Common regular medications omitted ranged from analgesics to psychotropic medications. Recording of justifications for medication omissions was inconsistent—only 48% of omissions had a recorded reason. A wide range of medications are regularly prescribed and administered to RAC home residents in NZ. Omitted doses are frequently recorded without a justification. Inconsistent recording of omissions can increase potential for error, particularly in relation to psychotropic medications. More consistent recording may help staff to maintain a high standard of quality care.
Publisher: Springer Science and Business Media LLC
Date: 05-08-2020
DOI: 10.1186/S12877-020-01674-W
Abstract: A medication omission is an event where a prescribed medication is not taken before the next scheduled dose. Medication omissions are typically classed as errors within Residential Aged Care (RAC) homes, as they have the potential to lead to harm if poorly managed, but may also stem from good clinical decision-making. This study aimed to quantify the incidence, prevalence, and types of medication omissions in RAC homes on a national scale, using a New Zealand-based s le. We conducted retrospective pharmacoepidemiology of de-identified medication administration e-records from December 1st 2016 to December 31st 2017. Four tiers of de-identified data were collected: RAC home level data (ownership, levels of care), care staff level data (competency level/role), resident data (gender, age, level of care), and medication related data (omissions, categories of omissions, recorded reasons for omission). Data were analysed using SPSS version 24 and Microsoft Excel. A total of 11, 015 residents from 374 RAC homes had active medication charts 8020 resided in care over the entire s le timeframe. A mean rate of 3.59 medication doses were omitted per 100 (±7.43) dispensed doses/resident. Seventy-three percent of residents had at least one dose omission. The most common omission category used was ‘not-administered’ (49.9%), followed by ‘refused’ (34.6%). The relationship between ownership type and mean rate of omission was significant ( p = 0.002), corporate operated RAC homes had a slightly higher mean (3.73 versus 3.33), with greater variation. The most commonly omitted medications were Analgesics and Laxatives. Forty-eight percent of all dose omissions were recorded without a comment justifying the omission. This unique study is the first to report rate of medication omissions per RAC resident over a one-year timeframe. Although the proportion of medications omitted reported in this study is less than previously reported by hospital-based studies, there is a significant relationship between a resident’s level of care, RAC home ownership types, and the rate of omission.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Monique Jonas.