Pharmacy Practice, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.
Social Research Methodology, School of Health Sciences, University of East Anglia, Norfolk NR4 7TJ, United Kingdom.
Int J Pharm. 2016 Oct 30;512(2):416-421. doi: 10.1016/j.ijpharm.2016.02.036. Epub 2016 Feb 22.
In the UK, 69.5% of residents in care homes are exposed to one or more medication errors and 50% have some form of dysphagia. Hospital research identified that nurses frequently crush tablets to facilitate swallowing but this has not been explored in care homes. This project aimed to observe the administration of medicines to patients with dysphagia (PWD) and without in care homes.
A convenient sample of general practitioners in North Yorkshire invited care homes with nursing, to participate in the study. A pharmacist specialised in dysphagia observed nurses during drug rounds and compared these practices with national guidelines. Deviations were classified as types of medication administration errors (MAEs).
Overall, 738 administrations were observed from 166 patients of which 38 patients (22.9%) had dysphagia. MAE rates were 57.3% and 30.8% for PWD and those without respectively (p<0.001). PWD were more likely to experience inappropriate prescribing (IP). Signs of aspiration were more frequently observed in PWD when IP occurred (p<0.001).
Observation of medication administration practices by independent pharmacists may enable the identification of potentially dangerous practices and be used as a method of staff support. Unidentified signs of aspiration suggest that nurses require training in dysphagia and need to communicate its presence to the resident's GP. Further research should explore the design of an effective training for nurses.
在英国，69.5%的养老院居民遭受过一次或多次用药错误，50%的养老院居民有某种形式的吞咽困难。医院的研究发现护士经常将药片压碎以方便吞咽，但这在养老院中尚未得到探讨。本项目旨在观察养老院中吞咽困难（PWD）患者和无吞咽困难患者的用药情况。
北约克郡的一位全科医生对参与研究的养老院进行了一项方便抽样调查。一位专门研究吞咽困难的药剂师在发药轮班时观察护士的操作，并将这些操作与国家指南进行比较。偏差被归类为药物管理错误（MAE）的类型。
总体而言，从 166 名患者中观察到 738 次给药，其中 38 名患者（22.9%）有吞咽困难。吞咽困难患者的 MAE 发生率为 57.3%，无吞咽困难患者的 MAE 发生率为 30.8%（p<0.001）。吞咽困难患者更有可能出现不适当的处方（IP）。当出现 IP 时，吞咽困难患者更频繁地出现吸入迹象（p<0.001）。
由独立药剂师观察用药管理实践可能能够识别潜在的危险做法，并可用作员工支持的一种方法。未识别出的吸入迹象表明，护士需要接受吞咽困难培训，并需要将其存在告知居民的全科医生。进一步的研究应探讨为护士设计有效的培训方案。
