title: Improving medication administration in nursing home residents with swallowing difficulties: sustainability of the effect of a multifaceted medication safety programme.
abstract: BACKGROUND
  Crushing solid oral dosage forms is an important risk factor for medication administration errors (MAEs) in patients with swallowing difficulties. Nursing home (NH) residents, especially those on psychogeriatric wards, have a high prevalence of such difficulties.
  
  
  BACKGROUND
  Six different psychogeriatric wards in two Dutch NH facilities, participating over a total period of 1 year divided into preintervention, implementation, and the first and second evaluation period.
  
  
  METHODS
  Number of MAEs per number of observed medication administrations calculated for all and three subtypes of MAEs: crushing-uncrushable-medication, inappropriate-technique, and food-drug interactions.
  
  
  METHODS
  The intervention included (i) education for nursing staff about crushing medication safely, (ii) a medication administration protocol for patients with swallowing difficulties, (iii) a 'do-not-crush-medication' pocket card for the nursing staff, (iv) screening of medication charts by pharmacy technicians on potential crushing problems, and (v) advices on medication charts on safe medication administration to residents with swallowing problems.
  
  
  RESULTS
  The number of crushing uncrushable medication errors, an MAE subtype with the highest potential risk for patient harm, was reduced significantly from 19 (9.6%) to 7 (3.0%; first evaluation period), adjusted odds ratio 0.20 (OR = 95%CI, 0.07-0.55). During the second evaluation period, the proportion crushing uncrushable medications errors was the only outcome that remained significantly lower in comparison with the preintervention period (p = 0.045).
  
  
  CONCLUSIONS
  Introduction of a multifaceted medication safety programme in NH facilities by a pharmacy team is a tool towards safer medication administration practice in residents with swallowing difficulties. Commitment on organisational level is, however, vital to achieve sustainable improvements.
authors.affiliation: Academic Medical Centre, Department of Hospital Pharmacy, Amsterdam, the Netherlands; ApoMed, Amsterdam, the Netherlands. ccmstuijt@upcmail.nl
authors.forename: Clementine C M
authors.initials: CC
authors.lastname: Stuijt
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Klopotowska
authors.forename: Chantal
authors.initials: C
authors.lastname: Kluft-van Driel
authors.forename: Nhut
authors.initials: N
authors.lastname: Le
authors.forename: Jan
authors.initials: J
authors.lastname: Binnekade
authors.forename: Bea
authors.initials: B
authors.lastname: van der Kleij
authors.forename: Tjalling
authors.initials: T
authors.lastname: van der Schors
authors.forename: Patricia
authors.initials: P
authors.lastname: van den Bemt
authors.forename: Loraine
authors.initials: L
authors.lastname: Lie-A-Huen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D009735:Nursing Homes; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D015397:Program Evaluation; D011446:Prospective Studies
chemical_list: D004364:Pharmaceutical Preparations