Home care nurses' management of high-risk medications: a cross-sectional study.

BACKGROUND: High-risk medications use at home entails an increased risk of significant harm to the patient. While interventions and strategies to improve medications care have been implemented in hospitals, it remains unclear how this type of medications care is provided in the home care setting. The objective was to describe home care nurses' management of high-risk medications. METHODS: A cross-sectional, descriptive design was set up in home care nurses in Flanders, Belgium. Participants were recruited through convenience sampling and could be included in the study if they provided medications care and worked as a home care nurses. Participants completed an online structured questionnaire. Questions were asked about demographic information, work experience, nurses' general attitude regarding high-risk medications, contact with high-risk medications and the assessment of risk and severity of harm, specific initiatives undertaken to improve high-risk medications care and the use of additional measures when dealing with high-risk medications. Descriptive statistics were used. RESULTS: A total of 2283 home care nurses participated in this study. In our study, 98% of the nurses reported dealing high-risk medications. Home care nurses dealt the most with anticoagulants (96%), insulin (94%) and hypnotics and sedatives (87%). Most nurses took additional measures with high-risk medications in less than 25% of the cases, with the individual double check being the most performed measure for all high-risk medications except lithium. Nurses employed by an organization received support mostly in the form of a procedure while self-employed nurses mostly look for support through external organizations and information sources. CONCLUSIONS: The study shows several gaps regarding high-risk medications care, which can imply safety risks. Implementation and evaluation of more standardized high-risk medications care, developing and implementing procedures or guidelines and providing continuous training for home care nurses are advised.

High-Risk Medication in Home Care Nursing: A Delphi Study.

AIMS: The aims of the study were to reach consensus on which medications in home care nursing should be considered high-risk medication (HRM) and to obtain recommendations about which interventions home care nurses can perform to improve quality of care and safety in managing these HRM. DESIGN: This is an international Delphi study with 13 purposively selected experts from 4 different countries. METHODS: A 3-round iterative Delphi survey was conducted from May 2018 to October 2018, based on a list of 32 medications previously reported as HRM in community care. A proposal for HRM was based on this literature search, and experts were asked to reflect on which (groups of) medications should be considered HRM by home care nurses (completeness of the list, risk assessment per [group of] medication, the need for home care nurse interventions, and the need for an HRM care procedure). The cutoff point for consensus was set at 80% of expert agreement. RESULTS: The panel assessed the initial list and added 30 (groups of) medications. In the last round, consensus of 80% or more was reached for 27 (groups of) medications to be considered HRM by home care nurses. For 28 medications, additional interventions by a home care nurse were considered warranted. A procedure or protocol for home care nurses was deemed necessary for 12 medications. CONCLUSIONS: We identified a set of (groups of) medications that should primarily be considered HRM by home care nurses.Impact:• What problem did the study address? This study clarified which medications should be considered HRM by home care nurses.• What were the main findings? Experts identified a set of 27 (groups of) medications that should primarily be considered HRM by home care nurses.• Where and on whom will the research have an impact? The results provide essential information for home care agencies when setting up an HRM policy.

Infection prevention and control challenges in Flemish homecare nursing: a pilot study.

Home nursing is evolving towards more invasive care. Nevertheless, no national data are available on the prevalence of HAI in this setting. The aim of this pilot study is to explore the Flemish home care setting as a first step toward a national surveillance program. A survey, focused on patient characteristics and HAI, was conducted between 7 May and 20 July 2018 on 711 Flemish patients. Most of the patients (74%) are 65 years or older and half of them had a form of comorbidity. Assisting with personal hygiene and wound care were the most frequent services delivered by home care nurses. A comparison of the prevalence of infections diagnosed by a physician or applying uniform criteria (ECDC), revealed a similar prevalence of skin and soft tissue infections (9% vs. 8.5%) and urinary tract infections (4% vs. 4.5%). A positive MDRO-screening was found in 6% of the patients. This pilot study is a first step towards a standardized national surveillance in home care to collect information on the prevalence of HAI and it reveals several interesting facts and study pitfalls for this setting.

High-risk medication in community care: a scoping review.

PURPOSE: To review the international literature related to high-risk medication (HRM) in community care, in order to (1) define a definition of HRM and (2) list the medication that is considered HRM in community care. METHODS: Scoping review: Five databases were systematically searched (MEDLINE, Scopus, CINAHL, Web Of Science, and Cochrane) and extended with a hand search of cited references. Two researchers reviewed the papers independently. All extracted definitions and lists of HRM were subjected to a self-developed quality appraisal. Data were extracted, analysed and summarised in tables. Critical attributes were extracted in order to analyse the definitions. RESULTS: Of the 109 papers retrieved, 36 met the inclusion criteria and were included in this review. Definitions for HRM in community care were used inconsistently among the papers, and various recurrent attributes of the concept HRM were used. Taking the recurrent attributes and the quality score of the definitions into account, the following definition could be derived: "High-risk medication are medications with an increased risk of significant harm to the patient. The consequences of this harm can be more serious than those with other medications". A total of 66 specific medications or categories were extracted from the papers. Opioids, insulin, warfarin, heparin, hypnotics and sedatives, chemotherapeutic agents (excluding hormonal agents), methotrexate and hypoglycaemic agents were the most common reported HRM in community care. CONCLUSION: The existing literature pertaining to HRM in community care was examined. The definitions and medicines reported as HRM in the literature are used inconsistently. We suggested a definition for more consistent use in future research and policy. Future research is needed to determine more precisely which definitions should be considered for HRM in community care.

Perspectives on the delegation of hygienic care in the context of home nursing: a qualitative study.

BACKGROUND: In light of current trends and healthcare evolutions, delegation of patient care from home nurses to health care assistants (HCAs) is increasingly important. Hygienic care is an essential component of nursing education and practice, yet it has rarely been the subject of scientific literature. AIM: To understand the opinions and experiences of home nurses and policy makers with regard to the meaning of hygienic care and the delegation of these acts in the context of home nursing. METHODS: A descriptive qualitative study (six focus groups with home nurses and two with policy makers from the Belgian home nursing sector). Content analysis of the data and the use of NVivo 11.0 software. FINDINGS: Hygienic care is a cyclical care process of continuously investing in a trusting relationship with a patient, assessing their care needs and ability for self-care and taking action and evaluating care as situations change. All of this must be mutally agreed with the patient and should consider their environment and lifestyle. The decision to delegate hygienic care is based on patient assessments and the patient's specific care needs using nursing diagnoses and indicators. Finally, barriers and facilitating factors for both delegating and providing hygienic care were addressed. CONCLUSION: Hygienic care is a crucial component of nursing care, that can be delegated to HCAs with the necessary supervision.

Organization of Hospital Nursing, Provision of Nursing Care, and Patient Experiences With Care in Europe.

This study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals in eight European countries shows that patient care experience is better in hospitals with better nurse staffing and a more favorable work environment in which less clinical care is left undone. Clinical care left undone is a mediator in this relationship. Clinical care is left undone less frequently in hospitals with better nurse staffing and more favorable nurse work environments, and in which nurses work less overtime and are more experienced. Higher proportions of nurses with a bachelor's degree reduce the effect of worse nurse staffing on more clinical care left undone.