目标:综合老年护理提供者,居民和居民“家庭成员”在老年护理设施中药物管理的观点和经验;确定药物管理错误的发生率,以及药物管理对老年护理机构护理质量和居民中心的影响。
方法:混合方法系统综述。
■CRD42023426990。
方法:AMED,CINAHL,MEDLINE,EMBASE,EMCARE,PsycINFO,在2023年6月搜索了Scopus和WebofScience核心数据库。
方法:纳入的研究进行独立筛选,由两名研究人员选择和评估。遵循系统审查和荟萃分析(PRISMA)清单的首选报告项目,使用混合方法评估工具进行批判性评估。数据的聚合合成,进行了主题综合和荟萃分析.
结果:纳入了128项研究(33项定性,85种定量方法和10种混合方法)。制定了五个主题,包括1)人员配置问题,2)居民角色的不确定性,3)与药物相关的决策,4)使用电子给药记录和5)给药错误。对老年护理人员的教育干预显着减少了药物管理错误,在五项研究中进行了检查(OR=0.37,95CI0.28-0.50,p<.001)。
结论:老年护理机构的药物管理在临床和人际关系层面上具有挑战性和复杂性。临床过程,用药错误和安全性仍然是实践的重点。然而,需要更积极地考虑居民的自主性和老年护理工作者和提供者的投入,以解决药物管理的人际和社会心理方面的问题。未来研究的新方向应该检查剂型修改背后的决策,老年护理人员“药物遗漏的定义和支持居民及其家庭成员在药物管理期间参与的实用方法”。
■重要的是,老年护理机构中的药物管理应被更明确地视为临床和人际任务。老年护理人员的临床决策需要更多的关注,特别是关于剂型修改,秘密管理和药物遗漏。以居民为中心的护理方法支持居民和家庭参与药物管理可能会提高依从性。满意度和护理质量。
结论:研究解决了什么问题?老年护理机构的药物管理是一项复杂的临床和人际交往活动。尽管如此,到目前为止,尚未尝试围绕这种做法综合定性和定量证据。有必要确定围绕老年护理人员的观点和经验存在哪些证据,居民和居民的家庭成员了解挑战,用药期间的人际机会和风险。主要发现是什么?缺乏以居民为中心的药物管理护理方法的经验证据,以及如何使居民和他们的家人有更多的投入。作为药物施用的一部分,剂量形式的修改公开和秘密地发生。不仅仅是作为吞咽困难的老年人的一种方法,而是强制遵守处方药。药物管理错误通常包括药物遗漏作为一类错误,尽管一些遗漏源于药物遗漏和居民输入的明确理由。这项研究将在哪里和对谁产生影响?:本系统评价的结果有助于老年护理政策和有关药物管理和与老年人接触的实践。这篇综述提出了一些发现,为老年护理人员在专业发展和实践反思方面提供了一个起点,特别是关于剂型修改的临床决策,药物管理错误和使居民输入药物管理的张力。对于研究人员来说,这项审查强调了开发以居民为中心的护理方法和干预措施的必要性,并评估这些是否会对药物管理产生积极影响,居民参与,坚持处方药物和护理质量。
■此系统评价是根据系统评价和荟萃分析的首选报告项目进行报告的(Page等。,2021)。
■本系统评价无患者或公众贡献。
OBJECTIVE: To synthesize aged care provider, resident and residents\' family members\' perspectives and experiences of medication administration in aged care facilities; to determine the incidence of medication administration errors, and the impact of medication administration on quality of care and resident-centredness in aged care facilities.
METHODS: A mixed-methods systematic
review.
UNASSIGNED: CRD42023426990.
METHODS: The AMED, CINAHL, MEDLINE, EMBASE, EMCARE, PsycINFO, Scopus and Web of Science core collection databases were searched in June 2023.
METHODS: Included studies were independently screened, selected and appraised by two researchers. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was followed, with the Mixed Methods Appraisal Tool was used for critical appraisal. Convergent synthesis of data, thematic synthesis and meta-analysis were performed.
RESULTS: One hundred and twenty-eight studies were included (33 qualitative, 85 quantitative and 10 mixed-methods). Five themes were formulated, including 1) Staffing concerns, 2) The uncertain role of residents, 3) Medication-related decision-making, 4) Use of electronic medication administration records and 5) Medication administration errors. Educational interventions for aged care workers significantly reduced medication administration errors, examined across five studies (OR = 0.37, 95%CI 0.28-0.50, p < .001).
CONCLUSIONS: Medication administration in aged care facilities is challenging and complex on clinical and interpersonal levels. Clinical processes, medication errors and safety remain focal points for practice. However, more active consideration of residents\' autonomy and input by aged care workers and providers is needed to address medication administration\'s interpersonal and psychosocial aspects. New directions for future research should examine the decision-making behind dose form modification, aged care workers\' definitions of medication omission and practical methods to support residents\' and their family members\' engagement during medication administration.
UNASSIGNED: It is important that medication administration in aged care facilities be more clearly acknowledged as both a clinical and interpersonal task. More attention is warranted regarding aged care workers clinical decision-making, particularly concerning dose form modification, covert administration and medication omissions. Resident-centred care approaches that support resident and family engagement around medication administration may improve adherence, satisfaction and quality of care.
CONCLUSIONS: What Problem Did the Study Address? Medication administration in aged care facilities is a complex clinical and interpersonal activity. Still, to date, no attempts have been made to synthesize qualitative and quantitative evidence around this practice. There is a need to establish what evidence exists around the perspectives and experiences of aged care workers, residents and resident\'s family members to understand the challenges, interpersonal opportunities and risks during medication administration. What Were the Main Findings? There is a lack of empirical evidence around resident-centred care approaches to medication administration, and how residents and their families could be enabled to have more input. Dose form modification occurred overtly and covertly as part of medication administration, not just as a method for older adults with swallowing difficulties, but to enforce adherence with prescribed medications. Medication administration errors typically included medication omission as a category of error, despite some omissions stemming from a clear rationale for medication omission and resident input. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The findings of this systematic
review contribute to aged care policy and practice regarding medication administration and engagement with older adults. This
review presents findings that provide a starting point for aged care workers in regards to professional development and reflection on practice, particularly around clinical decision-making on dose form modification, medication administration errors and the tension on enabling resident input into medication administration. For researchers, this review highlights the need to develop resident-centred care approaches and interventions, and to assess whether these can positively impact medication administration, resident engagement, adherence with prescribed medications and quality of care.
UNASSIGNED: This systematic
review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al., 2021).
UNASSIGNED: No patient or public contribution to this systematic
review.