Drug-related problems : nurses' role and responsibility

Drug-related problems (DRPs) are common and can cause serious adverse effects, even death. The elderly are an exposed group having a higher prevalence of DRPs. As nurses are involved in all steps of the medication process they are particularly well positioned to detect, prevent and alert for DRPs. Nurses are usually situated in thefrontline when medication errors occur and are thus exposed to being responsible for such. The aims of this thesis was to evaluate if nurses can improve the quality of drug therapy, and to investigate what types of medication error most frequently reported and which factors most frequently preceded an error.

Study I was designed to determine whether medication reviews made by a clinical pharmacologist and a nurse could affect rates of re-hospitalisation and/or death in hospitalized patients. DRPs detected and judged to be of clinical relevance resulted in written advice to the physician in charge of the patient. In 150 patients, 299 DRPs were found which resulted in 106 advice´s to the physicians. After 6 months readmission and death was measured and compared with patients in a control group receiving usual care, and there was no statistically significant difference in the two groups.

In Study II 15 nurses conducted structured, nurse-led medication reviews after a 1-day education in clinical pharmacology. The nurses identified 59 clinically relevant DRPs in 80 patients, not detected by the usual care. Out of these, 37 DRPs resulted in an intervention such as dose reduction or withdrawal of one or more drugs.

Study III was designed to determine whether medication reviews made by nurses could improve the quality of the drug therapy of elderly hospitalized patients. In 250 patient, 86 clinically significant DRPs were found not detected by the usual care. After 3 months re-admission and inappropriate drug use were measured and compared with patients in a control group receiving usual care, and there was no statistically significant difference in the two groups.

In Study IV a content analysis was used to develop a tentative classification model of medication errors and contributing factors. The findings showed a high level of complexity with system and human factors interacting.

In Study V 585 errors made by nurses were analyzed. Inexperienced nurses and male nurses were reported for a higher number of medication errors than their number in Sweden would lead one to expect. Lack of knowledge was a contributing factor more often associated with inexperienced nurses. Practice beyond scope of practice was more often associated with male nurses.

Conclusion, DRPs are common. By using nurse-led medication review DRPs not detected by the usual care could be found. Medication errors made by nurses are a result of interrelated human and system factors. Experienced nurses can be a valuable resource for improving the quality of drug-treatment and for ensuring patient safety.

List of scientific papers

I. Mannheimer B, Ulfvarson J, Eklöf S, Bergqvist M, Andersén-Karlsson E, Pettersson H, von Bahr C (2006). "Drug-related problems and pharmacotherapeutic advisory intervention at a medicine clinic." Eur J Clin Pharmacol 62(12): 1075-81. Epub 2006 Oct 26
https://pubmed.ncbi.nlm.nih.gov/17066294

II. Bergqvist M, Ulfvarson J, Andersen Karlsson E, von Bahr C (2008). "A nurse-led intervention for identification of drug-related problems." Eur J Clin Pharmacol 64(5): 451-6. Epub 2008 Jan 19
https://pubmed.ncbi.nlm.nih.gov/18204835

III. Bergqvist M, Ulfvarson J, Karlsson EA (2009). "Nurse-led medication reviews and the quality of drug treatment of elderly hospitalized patients." Eur J Clin Pharmacol 65(11): 1089-96
https://pubmed.ncbi.nlm.nih.gov/19798491

IV. Bergqvist M, Andersén Karlsson E, Sparring Björkstén K, Ulfvarson J (2009). "Medication errors by nurses in Sweden -classification and contributing factors." (Submitted)

V. Bergqvist M, Andersén Karlsson E, Sparring Björkstén K, Modigh C, Benson L, Ulfvarson J (2010). "Medication errors made by nurses - a result of interrelated human and system factors." (Manuscript)