Visiting nurses' posthospital medication management in home health care: an ethnographic study

BackgroundMedication management is the most challenging component of a successful transition from hospital to home, a challenge of growing complexity as the number of older persons living with chronic conditions grows, along with increasingly specialised and accelerated hospital treatment plans. Thus, many patients are discharged with complex medication regimen instructions, accentuating the risk of medication errors that may cause readmission, adverse drug events and a need for further health care. AimThe aim of this study was to explore visiting nurses' medication management in home health care after hospital discharge and to identify key elements in patient medication for improved patient safety. MethodInspired by the ethnographic research cycle, participant observations and informal interviews were conducted at 12 initial visits by a nurse in a patient's home after hospital discharge. Data consisted of field notes and photographs from the patients' homes, medication lists and medical records. Field notes were analysed in four steps. FindingsThe analysis showed 12 stages in medication management in which nurses strove to adjust medication management to the patients' actual health status by mediating on knowledge of the patient, information to the patient and on rules and regulations and by establishing order in medication lists and medications in the home. ConclusionThe nurse-patient relationship, the integration of care and the context of care challenged patient safety in visiting nurses' medication management in patients' homes after hospital discharge. The implications for practice were the following: to ensure nurses' opportunities to continuously evolve their observation skills and skills in making sound clinical judgements; to establish interprofessional working processes which support the continuous assessment of patients' needs and the adjustment of care and treatment; to clarify expectations to nurses' responsibility and patients' privacy.