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26.4.2017
Safety measures for medication in nursing homes | Sykepleien
Safety measures for medication in nursing homes PEER REVIEWED RESEARCH PUBLISERT: 26.04.2017 |
OPPDATERT: 26.04.2017
NUMEROUS NEW CHALLENGES: Nurses are constantly being introduced to new drugs, generic drugs and new methods of administering them. (Illustrasjonsfoto: Erik M. Sundt)
AUTHORS Marit Storli Sykepleier, cand.polit. og førstelektor Institutt for sykepleievitenskap, Fakultet for helse og sosialvitenskap, NTNU Norges teknisk naturvitenskapelig universitet Oddbjørn Ingebrigtsen Sosiolog, cand.polit. og førstelektor Institutt for sykepleievitenskap, Fakultet for helse og sosialvitenskap, NTNU Norges teknisk naturvitenskapelig universitet Sigrid Nakrem Sykepleier, MSc, ph.d. og professor Institutt for sykepleievitenskap, Fakultet for helse- og sosialvitenskap, NTNU Norges teknisk naturvitenskapelig universitet Toril A. Elstad Psykiatrisk sykepleier, cand.polit., ph.d. og førsteamanuensis https://sykepleien.no/en/forskning/2017/04/safetymeasuresmedicationnursinghomes#footer
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Institutt for anvendt sosialvitenskap, Fakultet for helse- og sosialvitenskap, NTNU Norges teknisk naturvitenskapelig universitet
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New reform and time-conuming tak uch a cleaning, preparing food and poor ICT olution mean that nure give le priorit to afet meaure in connection with medication management. SUMMARY Background: Medication errors are among the most common adverse events in the health and care services. The Norwegian Coordination Reform entails that nursing homes now have increased responsibility for medical treatment and no longer merely have responsibility for nursing care. Adverse events in health care have a great potential for improvement and can be prevented by implementing safety interventions. Purpose: To explore how safety measures function with a view to preventing the use of incorrect medication and adverse drug treatment in nursing homes. Method: Qualitative design involving focus group interviews with nurses and student nurses, and a study of student nurses’ learning logs. The data collection started parallel with the introduction of the Norwegian Coordination Reform, and was conducted over a three year period. Data analysis was carried out by coding and categorising meaning. Results: Nurses and student nurses perceived that safety procedures were often impracticable due to shortage of time. There was also little correlation between tasks, staäng and medication competence. There was little focus on systematic competence building, and training in handling medication was not taken suäciently seriously. Conclusion: This study has shown that safety measures do not function adequately, and that there is an increasing need for personnel with relevant pharmaceutical expertise in nursing homes. An important question is how nursing competence can be utilised to improve patient safety in respect of medication.
Medication error are among the mot common advere event in the health and care ervice. The need for greater e ort to enure patient afet ha een documented in national guideline (1, 2, 3) and in the O cial Norwegian Report 2015:11 (4). Thi highlight the coniderale need to develop tem and culture in order to learn from error. Furthermore, manager mut e more aware of rik and mut enure that internal control are performed in ful lment of the municipalit’ dut to do o (5). In 2011, the Minitr of Health and Care ervice launched the national patient afet campaign ‘In afe Hand 24/7’ a a national programme in which correct ue of medication in nuring home i one of the prioritied area (2). Thi programme i carried forward in 2014–2018. The Coordination Reform entail that nuring home have greater reponiilit for treatment and not onl reponiilit for nuring and care. Care for patient in a nuring home i demanding https://sykepleien.no/en/forskning/2017/04/safetymeasuresmedicationnursinghomes#footer
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and require that the nure have wide-ranging competence (6). ecaue nuring home reident ue man medication at the ame time, thi increae the rik of interaction etween drug, ide e ect and incorrect medication (7).
The need to develop medication competence In order to prevent medication error, a variet of afet meaure are often implemented, for example training, and control of the prepared drug two memer of ta . Neverthele, a report from the Norwegian oard of Health uperviion in 2010 reveal eriou de ciencie in medication management in 51 out of 67 nuring home that were invetigated (8). Preure of time, poor coordination etween work tak, ta ng and competence a well a inadequate training are common, while following the introduction of the Coordination Reform, the complexit of nuring tak ha grown (9). Depite thi, a urve howed that tak uch a cleaning and preparing food a well a poor ICT olution tole time and attention from the care of patient (10). The nure tate that the need etter knowledge of pharmacolog and age-related phiological change (11). Alteren (12) found that tudent nure lacked knowledge and experience of handling medication. Another tud (13) howed that auming reponiilit for a nuring home ward, third-ear tudent gained experience of handling medication. renden et al. found that although the working environment in nuring home provided a olid ai for learning, there wa a lack of formal tructure to enhance competence (14).
Need for better guidelines International tudie how that medication error repreent a coniderale prolem (15–18). However, we mut quetion how e ective current tem are in dealing with non-conformance, particularl in term of whether error reporting tem and organiational meaure promote learning and improvement (19). Reearch ha revealed that there are conpicuou organiational arrier in the cae of advere event (16, 20). Interruption when preparing medicine, a lack of knowledge and few opportunitie to follow up the e ect and ide e ect are factor that in uence medication error (18, 20). A urve of four American nuring home on limiting medication error howed that the reporting tem were di cult to acce. There wa no information aout medication error reporting form and the follow-up of reported non-conformance wa poor (21). Guideline and tandard procedure that could reduce incorrect ue of medication often did not exit in nuring home (22). An international tud found that lack of time and training a well a a punitive culture were reaon for the failure of health peronnel to report medication error. The tud alo howed that a culture of learning and fairne helped to increae reporting (17).
Patient safety in nursing homes
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In order to anale patient afet, we have emploed Donaedian’ framework with it concept of tructure, proce and reult (23, 24). Procedure, guideline and training are afet meaure that are encompaed in the tructural apect of patient afet. According to Hjort (25), error in the health ervice are mainl the reult of tem error uch a time preure, lack of guideline, poor routine and the working environment. The tem approach entail analing underling caue and etalihing tem that detect advere event efore the have eriou conequence (26). Improvement aed on learning from advere event can e tudied uing Argri and chön’ concept of ingle loop and doule loop learning. While ingle loop learning involve adjuting ehaviour within the ame mind-et, doule loop learning quetion the aic perception underling action (27).
«Good afet provided that the work on preparing medication i not interrupted.» Patient afet in term of medication i an area that ha not een adequatel reearched in Norwegian nuring home. The purpoe of thi tud i to hed light on how di erent afet meaure function with regard to preventing medication error. afet meaure are undertood a intervention at the tructural and proceual level enuring correct handling of medicine.
Method The tud ha a qualitative deign with focu group interview a the main method of data collection. The focu group interview i a quick and non-reource-intenive method that can provide an inight into how nure think and act to afeguard patient afet, and thu give a deeper undertanding of medication ue in nuring home. Uing targeted group dicuion, the participant can exchange perception and experience (28). Individual learning log are included a additional data. Learning log are a tool ued in programme of profeional tud, and tudent ue them to log their experience of their clinical practice (29). We tarted collecting data mean of focu group interview with nure in 2012, the ame ear a the Coordination Reform wa initiated. With the implementation of the reform, tudent, teacher and the eld of practice paid coniderale attention to challenge aociated with handling medication. Thi wa particularl the cae in a teaching project at ør-Trøndelag Univerit College, in which third-ear tudent aumed reponiilit for a nuring home ward in order to undergo training in profeional management and the tranition proce from tudent to nure (13). According to Morgan (28), there hould e a u cientl large numer of focu group to provide adequate data to hed light on the reearch quetion. We acquired data on the Coordination Reform’ impact on medication in nuring home over time including the tudent who aumed reponiilit for the nuring home ward in the data collected. We conducted therefore two focu group interview with tudent in 2013 and 2014 in addition to collecting the learning log. https://sykepleien.no/en/forskning/2017/04/safetymeasuresmedicationnursinghomes#footer
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Sample All informant received information in writing aout voluntar participation, and we otained written conent. The Norwegian Centre for Reearch Data approved the project. We otained permiion to conduct the tud at two nuring home. One wa a large uran nuring home with over 100 place ditriuted among three large ward. The other wa ituated in a rural municipalit and had approximatel 60 place ditriuted among ve mall ward. The focu group of nure and a ocial educator were randoml made up of the ta on dut the da we carried out the interview and who had the ame formal competence in handling medication. We wanted to enure that factor related to poition level did not a ect the interaction (30). Hereinafter, we will refer to the pecial educator a part of the group of nure for reaon of anonmit. The eniorit of the participant varied from 6 month to 24 ear of practice. We carried out two focu group interview at the large nuring home and one at the mall nuring home, and two focu group interview with tudent at the ame nuring home. The focu group material incorporate the experience of 16 nure and 13 tudent nure. The learning log alo come from the ame nuring home in addition to a third nuring home that took part in the teaching project. Altogether 18 out of 69 learning log included the handling of medication a a elf-choen topic.
Data collection We compiled an interview guide uing Donaedian’ triad a a theoretical framework, aed on a previou hopital project (23, 31). The interview guide had three main theme:
• • •
Risk factors and safety measures Cooperation with others Reactions to medication errors, risk perception and risk assessment
Thi article i limited to tructural factor with pecial focu on afet meaure (tale 1). The article’ rt and econd author conducted the interview, which were recorded on tape and trancried.
Data analysis A previou data collection conducted at a hopital in connection with a related topic of reearch ued the ame method and a imilar interview guide, and reulted in relevant data generation. In https://sykepleien.no/en/forskning/2017/04/safetymeasuresmedicationnursinghomes#footer
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the nuring home project, ome of the dicuion were limited and were more akin to a group interview (30). When we compared the data, the nuring home interview provided coniderale information aout tructural factor, ut le information aout relational condition and culture. The content of the learning log varied. ome gave detailed information aout the handling of medication while other contained more uper cial decription. In ve focu group, the participant dicued the ame topic guided quetion in a emitructured interview guide. In the anali of the dicuion, ke topic largel paralleled the topic in the interview guide. The rt and econd author reviewed and dicued the interview text efore analing them uing Kvale’ method of coding and categoriing meaning (32). coding piece of text, the general topic of dicuion emerged. Categoriation took place further condening the data material through unifing everal code under one topic (ee tale 2). Thoe interviewed are regarded a informant or witnee who provide reliale information (32). The learning log are treated a individual interview data. The were coded and categoried in the ame wa a the focu group interview, and upplemented the data material.
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Ethical reퟢ�ections and discussion of methods We complied with the Helinki Declaration’ guideline on anonmit and con dentialit. ince information aout medication error ma e enitive, it wa vital to e aware of ethical apect in connection with the project (32). When reearching patient afet, a con ict of interet ma arie. On the one hand, con dentialit mut e afeguarded and a relationhip of trut with the interviewee upheld. On the other hand, it i incument on u to warn of an rik to patient afet or treatment that i not profeionall ound (32, 33). The interview did not give rie to an uch ethical dilemma. everal nuring home in the region were aked to participate ut onl two of them found it poile to allow everal nure to leave the ward at the ame time to participate in an interview. Thi retricted the readth of the data. The tudent who took part aumed reponiilit for a nuring home ward for two week. The had the ame functional area a the nure, apart from https://sykepleien.no/en/forskning/2017/04/safetymeasuresmedicationnursinghomes#footer
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the handling of drug, which wa alwa checked a nure. The tudent had le experience than the nure ut their trength wa their critical external gaze and their attention to theor. When we read through the od of material, it emerged that the nure and tudent had imilar experience. For thi reaon, the data anali doe not ditinguih etween the nure’ and the tudent’ experience. oth group are de ned a health peronnel, and in light of the principle of reponile conduct, prior learning and work experience i deciive for what tak the can perform in connection with the handling of medication (33).
Results xperience of how afet meaure functioned with regard to medication management in nuring home were divided into three main topic (tale 2):
• • •
Safety procedures Training and medication competence as safety measures Organisation of work and allocation of tasks
Incomplete safety procedures Veri cation two memer of ta wa a well-etalihed afet procedure. Two nure checked the election or preparation of medicine. If onl one nure wa on dut, a practitioner (for example, a care worker or a nuring aitant) could help to check. The medicine were placed in a pill dipener one week in advance, and were mot often ditriuted a nuring aitant. Two nure mixed the drug ued in the infuion pump, ut onl one changed the pump. The informant aid that after a near-accident, the ta had dicued whether there hould alo e two preent when changing the pump. At one of the nuring home, there wa a computer-controlled medicine cainet with inuilt control of the withdrawal and election of medication. ecure practice relied on there eing no interruption to the work on preparing the medication. It wa pointed out that the cainet wa too cramped, it wa di cult to get a full overview and it quickl ecame ver untid.
«Time preure and interruption characteried work on managing medication. » Written regulation on medication management were well implemented. However, according to the informant, there were man example of non-compliance with the afet procedure. Due to time preure, ometime the kipped a tep in the documentation routine. For example, the might forget to ign for the medicine adminitered, or the might ign for medicine that had not een handed out. A detailed example of a forgotten igning-o of a lood-thinning drug wa decried in a learning log. In the evening or at the weekend, the dipening of medicine often took place telephone. ometime it took a long time to get the doctor’ ignature, or it might e forgotten. A nure alo gave an example where a patient wa given the wrong tpe of https://sykepleien.no/en/forskning/2017/04/safetymeasuresmedicationnursinghomes#footer
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antiiotic ecaue no information wa noted aout the patient’ allerg to thi tpe of antiiotic.
A lack of case histories and non-conformance with procedures The informant poke of man epiode where cae hitorie were lacking, or an outdated cae hitor accompanied the patient when he/he wa dicharged from hopital. The lat-mentioned incident wa dicovered when the nuring home ward received the new cae hitor in the pot ome da later. If the nuring home aked the hopital aout a miing cae hitor, the might e told to ue the lit of medication, ut a one nure aid, ‘That’ jut a me ecaue it’ written hand, o ou don’t undertand a thing.’ uch inaccuracie ma reult in de cient or incorrect treatment of patient. Nor did the nuring documentation and the cae hitor alwa correpond. Coniderale time wa wated in calling the hopital to tr to otain the cae hitor or calling the doctor who had written it. A topic addreed in everal learning log wa non-conformance with procedure failing to adminiter medicine at the correct time, or forgetting to do o at all. Nure in everal focu group related that the were often too u to write error report. Time preure and a hortage of nure meant that the had to prioritie nuring tak that involved giving immediate help. The alo gave lower priorit to writing error report ecaue the felt it wa a wate of time. One nure aid ‘One ummer I wrote all the error report I poil could (not onl thoe related to medication) to map how much time I required to do thi properl. ometime I wa there one or two hour longer than the ordinar da hift on a completel voluntar ai and without eing paid overtime for it.’ Another nure claimed that onl eriou and oviou error were documented. ven though it did not take long to decrie the event, anwering the point ‘uggeted improvement’ wa timeconuming. The error report were reviewed on a weekl ai in all nuring home ward ut practice di ered regarding feedack to the ta .
Training and medication competence as safety measures The informant aid that the were contantl eing introduced to new drug, generic drug and new wa of adminitering them. ven experienced doctor expreed the view that there wa a huge numer of new thing. Two manufacturer might produce the ame drug ut under di erent name. A le experienced nure could eail elect the wrong drug. Although the chemit pulihed lit of all generic drug, nure did not alwa have time to conult the lit. In anwer to quetion aout training related to new drug, new method of adminitration and oervation of the e ect and ide e ect, one group anwered a follow: ‘I have never taken part in anthing like that (training in new medication).’ ‘In connection with the ue of a new pain-relieving naal pra, a nure from the hopital came along to how u a mart wa to hold it. We have to read up on the e ect and ide e ect of https://sykepleien.no/en/forskning/2017/04/safetymeasuresmedicationnursinghomes#footer
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medicine ourelve.’ everal of the other nodded in agreement, aing thing like: ‘… and we learn from each other…’ ‘… o we read the package information lea et …’ ‘We have a dut to keep updated at all time.’ The informant tated that training in medication management wa ‘ad hoc’ and poorl organied. The training conited of information heet, package information lea et, the app of the Norwegian Pharmaceutical Product Compendium on private moile phone, elf-tud and exchange of experience. No one had een o ered an training the pharmaceutical companie.
Work organisation and allocation of tasks The organiation of work and allocation of tak among health peronnel in connection with handling medication wa part of the afet meaure. Patient were precried medication variou actor uch a their GP, the nuring home phician and doctor from variou hopital department. At the nuring home, there were doctor’ viit once a week (twice a week in ome hort ta ward) with a routine review of medicine. At one of the nuring home, the doctor had a trong focu on unnecear medication. At the other nuring home, in contrat, oth the nure and the doctor paid le attention to polpharmac. A group of tudent nure dicued how ea it wa to reort to laxative and tranquillier to ave time intead of focuing on diet and activit. One tudent nure wrote a detailed learning log aout a patient who appeared to e conideral overmedicated with analgeic and pcho-pharmaceutical. The patient wa ver overweight, and the ide e ect of everal of the medication included drowine, an increaed need for leep and weight increae. The patient wa hopitalied for reaon of moiliation, ut at in the lounge and lept the whole da. The tudent attempted everal time to take thi up during the pre-viit conultation, ut to no avail ince it wa aid to e non-acute. Two more learning log alo dealt with patient who were overmedicated.
«There wa a lack of tematic competence uilding. » In the hort ta ward, the patient on occaion adminitered their medicine themelve, often without having the necear overview. One nure aid ‘The come along with a whole ox lled with medicine that the’ve collected and aved up for everal ear. The ak if the have to ue it, ecaue no one ha told them to top.’ If attempt were made to graduall reduce their medication, famil memer might protet ecaue the wanted active treatment for their loved one. One of the nuring home arranged cheduled meeting with famil memer twice a ear, opening for a dicuion of medication regime.
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In all nuring home ward, nure uuall prepared the medication, ut the were often adminitered a nuring aitant who had undergone a ix to twelve-hour coure of internal training. ach hift had few nure on dut. everal of the interview and learning log provided example howing that coniderale time wa pent on tiding, wahing and erving food – tak that do not require nuring competence. Man imultaneou, complicated nuring tak gave the nure little opportunit to work in a concentrated manner without interruption. At one of the nuring home, medication election wa allocated to di erent da of the week in order to hield the nure who handled medication.
Discussion Thi tud ha revealed that documentation a a afet procedure wa a rik factor ecaue it wa unreliale. Weaknee in patient record tem have previoul een documented at 56 Norwegian nuring home (8). Another tud how that error in medication information wa one of the mot common advere event when patient are tranferred etween di erent level of the health ervice (34). Nor do error report function atifactoril a afet meaure. The nuring home emplo error report, doule-checking and documentation when there i enough time, ut the participant decried man ituation when time preure made it impoile to follow afet procedure. Thi nding concur with international reearch (17, 21, 22) and how that there i a long wa to go to ful l the principle of doule loop learning (27). Thi tud i alo in line with Lipk (35), who a earl a 1980 decried how ‘treet-level ureaucrat’ were forced ‘to take hort cut’ in ituation with di cult prioritie. Decription of inaccurate documentation and a lack of error report recurred during the data collection period of almot three ear. Thi indicate a failure to improve afet meaure, which in turn indicate poor follow-up of internal control (5). The reponile manager ha the formal reponiilit for medication management and rik aement (36). A 2015 urve alo decried time preure a the reaon that the writing of error report wa not given priorit, and that error reporting tem eldom reulted in improvement (37). Thi i a grave ituation ince the Coordination Reform entail greater and more complex medication eing adminitered the primar health ervice (3, 9). If afet procedure that cannot e realied in practice are retained, thi can undermine ta ’ undertanding of the importance of routine for patient afet. xact documentation of precried drug i eential to prevent medication error. ince utantial reource are ued oth for documentation and error report, we need further reearch to evaluate the ue of reource in order to improve patient afet in the nuring home.
Must build up competence systematically Our tud howed that time preure and interruption characteried work on medication management, while at the ame time coniderale time wa pent on tak that did not require nuring kill. Other urve and tudie alo point thi out (10, 18, 38), which can e interpreted https://sykepleien.no/en/forskning/2017/04/safetymeasuresmedicationnursinghomes#footer
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a indicating that training and the development of medication competence i not eing taken u cientl erioul. renden et al. howed that updating knowledge in nuring home wa carried out informall with a lack of formal management trategie to map competence and competence enhancement (14). Thi nding con rm that there i a lack of tematic competence uilding. The attending doctor i reponile for medication management ut i reliant on nure’ report on oervation of the e ect and ide e ect. uch report require that the nure have time to write them and profeional knowledge (7). The tud preent example in which tudent nure point to procedural error and overmedication. Thi indicate that the nure have competence that can e exploited in improving the medication regime in nuring home, o that competence uilding can e in line with the principle of doule loop learning (27). Further reearch i necear to examine wh nure give le priorit to afet meaure that can improve patient afet, and intead are carring out tak with conideral lower rik and need for competence uch a erving food, tiding and cleaning.
«Profeional identit mut e enhanced and the nure’ role hielded from tak that do not require nuring kill.» The Coordination Reform entail that the municipalit ha a much greater degree of reponiilit for treatment and no longer merel ha reponiilit for nuring and care. Thi change increae the need to uild up medication competence tematicall. When new health reform are introduced, there i little aement of what the conequence will e for patient afet (39). Our tud indicated that an overl high rik i aociated with medication management in nuring home. Nure are preent twent-four hour a da in nuring home ward and repreent a profeional group with formal medication competence. Thi tud ha hed light on the great need that nure and tudent nure have for medication competence, ut implie that there mut e realitic framework condition to appl and develop uch competence. In addition, the tud how that patient poil need training. A high rate of polpharmac ha een revealed a eing an underling caue of fall in connection with patient hopitalied in the pecialit health ervice (40). If patient and their famil memer have etter information and knowledge aout drug, thi can reduce unnecear medication ue.
Implications for education and practice The education of nure mut emphaie organiational competence in order to increae undertanding of the correlation etween afet meaure and patient afet (24–26, 41). Profeional identit mut e ooted, and the role of the nure hielded from tak that do not require nuring competence (6). Internal control in nuring home mut e improved. Nuring home management mut pa more attention to rik in connection with medication ue and make proviion for tematic training and development of medication competence, which mut take https://sykepleien.no/en/forskning/2017/04/safetymeasuresmedicationnursinghomes#footer
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place in relation to doule loop learning, including re ection and time to ae underling caue (27). Management mut alo facilitate training for patient and famil memer. The urve i aed on experience from a limited numer of nuring home ward, and mut e interpreted with care to avoid generaliation. However, the reult correlate well with Norwegian and international tudie on patient afet, medication ue and competence need in nuring home (6, 8, 11, 15, 16, 18, 20–22).
Conclusion The reult of thi tud decrie afet procedure that are not alwa feaile or reliale in practice. The training wa de cient and there wa poor correlation etween medication competence, work tak and ta ng. The Coordination Reform ha reulted in greater and more complex medication ue in nuring home, increaing the need for a tematic enhancement of medication competence. The reult of thi tud concur with everal imilar tudie and therefore raie the quetion of wh nuring competence i not etter utilied to enure patient afet. Coniderale reource are ued on tructural meaure uch a documentation and error report without thi having the optimal impact. Further reearch hould e carried out on how increaed nuring ta level and the development of medication competence can improve patient afet in nuring home.
References 1. Meld. t. 10. God kvalitet – trgge tjeneter. Kvalitet og paientikkerhet i hele- og omorgtjeneten. Olo: Hele- og omorgdepartementet. 2013. 2. Meld. t. 11. Kvalitet og paientikkerhet 2013. Olo: Hele- og omorgdepartementet. 2014–2015. 3. Meld. t. 26. Fremtiden primærheletjenete – nærhet og helhet. Olo: Hele- og omorgdepartementet. 2014–2015. 4. NOU 2015:11. Med åpne kort. Foregging og oppfølging av alvorlige hendeler i hele- og omorgtjeneten. Olo: Hele- og omorgdepartementet. 2015. 5. Hele- og omorgdepartementet. Forkrift om internkontroll i hele- og omorgtjeneten. 1. januar 2003 (Internkontrollforkriften). Availale at: http://lovdata.no/dokument/F/forkrift/2002-12-20-1731 (Downloaded 23.10.15). 6. ing-Jonon PC, jørk IT, Hofo D, Kirkevoll M, Fo C. Competence in advanced older people nuring: development of «Nuring older people – competence evaluation tool». International Journal of Older People Nuring 2015; 10:59–72.
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7. Kirkevold M, rodtkor K, Ranho AH. Geriatrik kepleie. God omorg til den gamle paienten. 2 utgave. Olo: Gldendal Akademik. 2014. 8. Heletilnet. årare paienter – utrgg tilrettelegging. Funn ved tiln med legemiddelehandling i jukeheimar 2008–2010. Report from Heletilnet 7/2010. Olo: Heletilnet. 2010. 9. Gautun H, e A. amhandlingreformen. Nova-report no. 8/2013. Olo: Nork Intitutt for forkning, oppvekt, velferd og aldring. 2013. 10. Hoftad . luttet i protet. Tidtvene gjorde at jeg a opp på kehjemmet. Olo: kepleien 2014;12:24–31. Availale at: http://kepleien.no/reportaje/2014/10/luttet-i-protet (Downloaded 17.11.2016). 11. Wanneo W, agmo L. tort ehov for mer kunnkap om legemidler lant kepleiere i kehjem. kepleien Forkning 2013;8(1):26–34. Availale at: http://kepleien.no/forkning/2013/01/tort-ehov-mer-kunnkap-om-legemidler-lantkepleiere-i-kehjem (Downloaded 17.11.2016). 12. Alteren J. Å lære legemiddelhåndtering i kehjem. kepleietudentene utfordringer. Vård i Norden 2012;32(4):34–8. 13. lekken L, Med AO, Forord T. Læringuttte i kepleiefaglig ledele etter praki der kepleiertudenter overtok anvaret for en avdeling. kepleien Forkning 2013;4(8):344–52. Availale at: http://kepleien.no/forkning/2013/11/laeringuttte-i-kepleiefaglig-ledeleetter-praki-der-kepleiertudenter (Downloaded 17.11.2016). 14. renden TK, torhei AJ, Grov K, Ytrehu . Kompetaneutvikling i kehjem – anatte perpektiv. Nordik Tidkrift for Heleforkning 2011;7(1):61–75. 15. Lane J, Trover JL, Dienemann JA, Laditka , lanchette CM. ect of killed nuring facilit tructure and proce factor on medical error during nuring home admiion. Health Care Management Review 2014; 39(4):340–51. 16. Lim RHM, Anderon J, uckle PW. Work domain anali for undertanding medication afet in care home in ngland: an explorator tud. rgonomic 2016; 59(1):15–26. 17. Holmtrom A, Airakinen M, Wei M, Wuliji T, Chan X, Laakonen R. National and local medication error reporting tem. A urve of practice in 16 countrie. Journal of Patient afet 2012; 8(4):165–76. 18. Dille T, levier MM, van Rompae , van ortel LM, Vander tichele RR. arrier for nure to afe medication management in nuring home. Health Polic and tem. 2011; 43(2):165–76. https://sykepleien.no/en/forskning/2017/04/safetymeasuresmedicationnursinghomes#footer
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Safety measures for medication in nursing homes | Sykepleien
19. tavropoulou C, Dohert C, Toe P. How e ective are incident-reporting tem for improving patient afet? A tematic literature review. The Milank Quarterl 2015; 93(4):826– 66. 20. arer ND, Alldred DP, Ranor DK, Dickinon R, Gar eld et al. Care home’ ue of medicine tud: Prevalence, caue and potential harm of medication error in care home for older people. Qualit and afet in Health Care 2009;18:341–6. 21. Handler M, Perera , Olhank F, tudenki A, Nace DA, Fridma D, Hanlon JT. Identifing modi ale arrier to medication error reporting in the nuring home etting. Journal of the American Medical Director Aociation 2007;8(9):568–74. 22. arne L, Cheek J, Nation RL, Gilert A, Paradio L, allantne A. Making ure the reident get their talet: medication adminitration in care adminitration in care home for older people. Journal of Advanced Nuring 2006;56(2):190–9. 23. Donaedian A. The de nition of qualit and approache to it aement. Michigan: Health Adminitration Pre. 1980. 24. Caraon P, Wetterneck T, Rivera-Rodriguez AJ, Hundt A, Hoonakker P, Holden R, Ae PG. Human factor tem approach to healthcare qualit and patient afet. Applied rgonomic 2014;45:14–25. 25. Hjort PF. Uheldige hendeler i heletjeneten. Olo: oial- og heledirektoratet. 2004. 26. Aae K. Paientikkerhet. Teori og praki. 2. ed. Olo: Univeritetforlaget. 2015. 27. Argri C, chön, D. Organizational learning II. Michigan: Addion-Wele Pulihing Compan. 1996. 28. Morgan DL. Focu group a qualitative reearch. 2. ed. California: Thouand Oak age Pulication. 1997. 29. Klemp T. Med prakiloggen om vandretav. n kvalitativ tudie av lærertudenter læringproe. (Doctoral diertation). Trondheim: NTNU. 2012. 30. Halkier . Fokugrupper. Olo: Gldendal Nork Forlag. 2010 31. torli M. Feilmediinering i kehu – organiajonkulturen påvirkning. Vård i Norden 2008;3(28):19–23. 32. Kvale . Det kvalitative forkningintervju. Olo: Ad Notam Gldendal. 1997. 33. Molven O. kepleie og ju, 4. ed. Olo: Gldendal. 2012 https://sykepleien.no/en/forskning/2017/04/safetymeasuresmedicationnursinghomes#footer
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Safety measures for medication in nursing homes | Sykepleien
34. Meteig M, Helleotad J, letvold O, Rotad T, altvedt I. Unwanted incident during tranition of geriatric patient from hopital to home: a propective oervational tud. MC Health ervice Reearch 2010;10:1. 35. Lipk M. treet-level ureaucrac. Dilemma of the individual in pulic ervice. New York: Ruel age Foundation. 1980. 36. Heledirektoratet. Legemiddelhåndtering for virkomheter og heleperonell om ter helehjelp. Olo: Heledirektoratet. 2008. 37. Flatgård I. Avvik toppe og avvie. «Det er ukken om paer havreekken». Olo, kepleien 2015;3:32–8. 38. Allen D. Re-reading nuring and re-writing practice: toward an empiricall aed reformulation of the nuring mandate. Nuring Inquir 2004;11(4):271–83. 39. Aae K. Paientikkerhet. Teori og praki i heleveenet. Olo: Univeritetforlaget: 2010. 40. Flkemannen i Møre og Romdal, Nord-Trøndelag, ør-Trøndelag. Fallprojekt i Heleregion Midt-Norge, amlerapport etter Pilottudien 2010, Journaltudien 2011, Kommunetudien 2012. 41. Orvik A. Organiatorik kompetane. Innføring i profejonkunnkap og klinik ledele. Olo: Cappelen Damm Akademik. 2015. Sykepleien Forskning 2016 11(59801)(e-59801) DOI: 10.4220/Sykepleienf.2016.59801
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