New medication plan to promote patient safety for the elderly

Older persons with polypharmacy are at increased risk of harm from medications, and this issue is a global patient safety challenge. Harm may arise at all stages of medication use and may cause hospital admission, additional resource utilization and lower patient satisfaction. Older persons' participation in their own care may increase patient safety. New research from Jönköping University has taken a closer look at this and, among other things, has produced a prototype for a new medication plan.

In several studies, Malin Holmqvist, PhD student at the School of Health and Welfare, Jönköping University, and also clinical pharmacist at Region Jönköping County, has taken a closer look at elderly people's medication use and how, with the help of the elderly themselves, they can provide safer medication treatment and better follow-up. Among other things, a medication plan prototype has been developed that can promote patient safety.

The first study, Older persons' experiences regarding evaluation of their medication treatment - An interview study in Sweden, shows that older people want to be involved in follow-ups of their medication treatment - and that this can be an underutilized resource in the pursuit of safer medication treatment. At the same time, the study shows that older people trust that healthcare services constantly evaluates and ensures that they receive the right treatment. This trust can mean that the elderly do not question their drug treatment.

In the second study, Evaluation of older persons' medications: a critical incident technique study exploring healthcare professionals' experiences and actions, Malin Holmqvist sees several factors which, according to doctors and nurses in primary care, contribute to a good follow-up and evaluation of older persons' drug treatment. These factors are that there are sufficient resources in the workplace and that there is cooperation with the elderly, as well as with their relatives and with other health care personnel.

"By making constant adjustments in the work, according to the conditions that exist, the health care personnel contribute to preventing, drawing attention to, and reducing the risk of drug-related problems. Based on these results, we have then, in a co-design work that was carried out digitally during the pandemic, produced a so-called medication plan," says Malin Holmqvist.

Medication plan in collaboration between the elderly and healthcare staff

The design of the medication plan was developed in collaboration between older people and doctors and nurses in primary care. The aim is to give the elderly person and healthcare staff a joint picture of the purpose and goals of drug treatment, how and when it should be evaluated and who is responsible for doing what.

The third study is a so-called case study that takes a closer look at how the participants experienced the co-design work and what it came to. In the article How Older Persons and Health Care Professionals Co-designed a Medication Plan Prototype Remotely to Promote Patient Safety: Case Study the method itself is described and how the participants experienced co-designing. Among other things, the participants felt that the work was inclusive and created learning from each other's everyday life around drug treatment. A fourth article, which has been submitted for peer review but not yet published, looks at how the prototype itself should look. The participants agreed that the medication plan should be linked to the patient's existing medication list in the medical record.

Tested in primary care

"The participants believed that the medication plan should be able to support communication, continuity and interaction, and that the information in the medication plan should be sufficient and adapted to those concerned. It should also be easy to access and overview," says Malin Holmqvist.

According to the participants, the prototype developed has the potential to promote patient safety and enable increased patient involvement. However, they highlighted that it can be difficult to apply it in clinical everyday life. The prototype for the drug plan has therefore been tested in primary care and analysis of the data is now underway, which will be published in a final article.

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