Nurse and Pharmaceutical Care (NuPhaC)

Dr. Nienke Dijkstra, associate professor at the University of Applied Sciences Utrecht, the Netherlands did a research project in which a eHealth tool, eHOME, was developed that support interprofessional collaboration in pharmaceutical care. The project was performed in collaboration with prof. dr. Marieke Schuurmans, prof. dr. Lisette Schoonhoven, dr. Carolien Sino, and dr. Rob Heerdink.

The digital HOME-instrument (eHOME) support home care nurses in reporting, monitoring, and communicating drug-related problems interprofessionally. The eHOME-instrument is based on the observation list of the validated paper-based home care observation of medication-related problems by home care employees (HOME) instrument and expanded with a monitoring and interprofessional communication feature. In our project, an iterative human-centered design approach was applied, comprising of a Delphi round for context of use and user requirements followed by two series of pilots for testing the usability and redesign. Home care nurses, community pharmacists, and general practitioners were involved in the iterative development, and considered the eHOME-instrument to be a convenient, clear, and easy to use instrument.

We explored medication-related process problems reported by home care nurses using the eHOME-instrument, including the potential clinical consequences of possible administration errors. A retrospective descriptive study design was performed. Potential discomfort or clinical deterioration was assessed for 309 medication-related process problems in 120 patients. The problems involved: medication discrepancies (60.8%); an undelivered medication administration record list (33.3%); undelivered medication (5.2%); and excessive medication delivery (0.7%). A total of 180 (58.2%) problems were assessed as having the potential for moderate or severe discomfort or clinical deterioration in patients. The results underline the importance of the observation function of home care nurses and the need to prevent and to improve medication-related process problems.

References:

JMIR Human Factors - Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study

Potential Clinical Consequences of Medication Process Problems in Older Home Care Patients (clinmedjournals.org)

Rode Vlaggen Instrument (only in Dutch)