Improving Safety in the Medicines Use Process for Disabled Persons in Residential Facilities. Results from a Pilot Study

Abstract

Background: Persons with severe disability often require long-term or life-long placement in residential facilities. Although they often need complex medical treatment, most residential facilities in Denmark do not have staff with health care training. Objective: To improve knowledge on medication safety issues in residential facilities for persons with severe disability (mental illness or physical / intellectual disability) and to test if two clinical pharmacy services could be delivered to residential facilities by community pharmacies in order to improve safety. Setting: Four residential facilities with 47 residents and a pharmacist from the four community pharmacies delivering medicines to these facilities. Method: The pilot study aimed at development and assessment of feasibility of an intervention with two pharmaceutical care services: a quality improvement service supporting the residential facility in quality development of routines for handling medicines, and a pharmaceutical care oriented ‘medicines care’ service aimed at quality improvement of residents’ medication therapy. The ‘medicines care’ service included a technical medication review conducted by a community pharmacist, a ‘medicines care’ meeting at the residential facility, and if needed, a ‘multidisciplinary medicines management conference’. Main outcome measure: Number of completed services, characteristics of and solutions to identified medication therapy problems, suggested changes to routines for handling medicines and implementation thereof, the involved actors’ satisfaction with the intervention, and rated changes in staff’s knowledge and self-efficacy. Results: The quality improvement service resulted in 45 suggestions for changes towards safer routines for handling medicines, mostly concerning administration of medicines. Sixty-six medication therapy problems were identified in 30 of the 47 residents receiving the ‘medicines care’ service. Adverse drug reactions were the most frequent problems (31.8%). Of the 50 suggestions for solving medication therapy problems, 14 were implemented by the facilities, whereas 36 required involvement of the prescriber. The prescribers gave feedback on 22 suggestions of which they accepted 19 (86.4%). One multidisciplinary medicines management conference was conducted. Conclusion: The study generated important knowledge on safety issues in residential facilities, and revealed a number of medication therapy problems for the residents. The pharmaceutical care services were implementable and demonstrated a potential to improve safety, but this has to be confirmed in a larger prospective trial.