title: Medicines administration for residents with dysphagia in care homes: A small scale observational study to improve practice.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pharmacy Practice, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia. Electronic address: manuel.serranosantos@qut.edu.au.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Serrano Santos
authors.affiliation: Social Research Methodology, School of Health Sciences, University of East Anglia, Norfolk NR4 7TJ, United Kingdom. Electronic address: f.poland@uea.ac.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Poland
authors.affiliation: Pharmacy Practice, School of Pharmacy, University of East Anglia, Norfolk NR4 7TJ, United Kingdom. Electronic address: D.j.wright@uea.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Wright
authors.affiliation: York Road Surgery, Elvington, York, North Yorkshire YO41 4DY, United Kingdom. Electronic address: Timothy.longmore@nhs.net.
authors.forename: Timothy
authors.initials: T
authors.lastname: Longmore
mesh_terms: D003680:Deglutition Disorders / Q000188:drug therapy* / Q000453:epidemiology; D016503:Drug Delivery Systems / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000592:standards; D009735:Nursing Homes / Q000592:standards*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D012112:Residential Facilities / Q000592:standards; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D004364:Pharmaceutical Preparations
keywords: Care home with nursing; Deglutition; Deglutition disorders; Dysphagia; Medicines; Medicines administration; Nursing home; Prescribing; Swallowing difficulties