Abstract
BackgroundMedication management is a complex, error-prone process. The aim of this study was to explore what constitutes the complexity of the medication management process (MMP) in specialized home healthcare and how healthcare professionals handle this complexity. The study is theoretically based in resilience engineering.MethodData were collected during the MMP at three specialized home healthcare units in Sweden using two strategies: observation of workplaces and shadowing RNs in everyday work, including interviews. Transcribed material was analysed using grounded theory.ResultsThe MMP in home healthcare was dynamic and complex with unclear boundaries of responsibilities, inadequate information systems and fluctuating work conditions. Healthcare professionals adapted their everyday clinical work by sharing responsibility and simultaneously being authoritative and preserving patients’ active participation, autonomy and integrity. To promote a safe MMP, healthcare professionals constantly re-prioritized goals, handled gaps in communication and information transmission at a distance by creating new bridging solutions. Trade-offs and workarounds were necessary elements, but also posed a threat to patient safety, as these interim solutions were not systematically evaluated or devised learning strategies.ConclusionsTo manage a safe medication process in home healthcare, healthcare professionals need to adapt to fluctuating conditions and create bridging strategies through multiple parallel activities distributed over time, space and actors. The healthcare professionals’ strategies could be integrated in continuous learning, while preserving boundaries of safety, instead of being more or less interim solutions. Patients’ and family caregivers’ as active partners in the MMP may be an underestimated resource for a resilient home healthcare.
Highlights
Medication management is a complex, error-prone process
To manage a safe medication process in home healthcare, healthcare professionals need to adapt to fluctuating conditions and create bridging strategies through multiple parallel activities distributed over time, space and actors
Patients’ and family caregivers’ as active partners in the management process (MMP) may be an underestimated resource for a resilient home healthcare
Summary
Medication management is a complex, error-prone process. The aim of this study was to explore what constitutes the complexity of the medication management process (MMP) in specialized home healthcare and how healthcare professionals handle this complexity. Medication management is a complex, error-prone process [3, 4] which in Sweden includes the following steps: prescription, preparation, administration, requisition, control (of narcotics) and storage of drugs [5]. Mistakes during the medication management process, i.e., medication errors, Recent improvements in medical knowledge and technology have made it possible to transfer administration of potent drugs and the use of complex technology into patient homes [10], making home healthcare with advanced health interventions a growing arena [7, 11, 12]. As one cannot control complex processes through standardization or linear thinking, we should consider new ways of handling gaps or patient safety risks
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