gms | German Medical Science

Background: The medication process in hospitals is a high-risk process in which errors can occur at any stage of the medication management process. It has been shown that the introduction of computerized systems specifically the switch from a ward stock system (WSS) to unit dose dispensing system (UDDS) help to reduce medication-related problems and improve the safety and efficiency of medication administration in healthcare facilities [1]. This is especially important in elderly patients who are at higher risk of developing drug-related problems due to polymedication and the prescription of inadequate medication. Very few studies describe potential barriers in the implementation of the UDDS. In this study we used a questionnaire which for the first time allows analysis of changes in medication management on wards with elderly patients. The aim of this investigation was to survey doctors and nursing staff about the acceptance and feasibility of unitdose care in a geriatric clinic at a university hospital.

Materials and Methods: The initial stage of the study entailed conducting orientation interviews with the objective of identifying the most relevant topics. 8 topic complexes with more than 60 questions were then created for the questionnaire, including topics such as drug therapy safety, handling the blistered medication on the ward as well as prescription and delivery times. The questionnaire was constructed using a mixed method design compromising a unipolar and bipolar, odd 5-point Likert scale. Reliability and validity of the questionnaire was ensured by means of a pretest. The survey was distributed to all nursing staff and doctors in the clinic of geriatric medicine at Jena University Hospital (nursing staff n=21, doctors n=11).

Results: The response rate to the survey was 74% (60% nursing staff and 100% doctors). The majority of respondents agreed that the unit dose system of medication distribution enhances drug therapy safety by ensuring the dual control principle. However, the application instructions provided and comprehensive medication review by pharmacists as part of unit dose supply also contribute to improving drug therapy safety. In response to a query regarding the handling unit dose packages on the ward, 66% of the nursing staff confirmed that they check the unit dose packages in order to take possible acute medication changes into account. When asked whether the blister packs are given to geriatric patients, the majority responded in the negative. Impaired fine motor skills, cognitive deficits, dementia and delirium were cited as the main reasons why blister packs should not be given to geriatric patients. It was shown that discharge management has become easier thanks to unit dose supply, thus supporting the transition from inpatient to outpatient care. The survey showed that the majority of doctors and nursing staff support unit dose supply and generally consider its implementation to be sensible.

Conclusion: In this study, we confirmed a high level of acceptance of UDDS, including in the care of geriatric patients. However, for successful implementation in geriatrics patients, appropriate adjustments to unit dose supply are necessary prior to implementation. For instance the distribution of blister-packed medicines to elderly patients was viewed critically by both doctors and nursing staff. Medication changes must also be safely integrated into the new care process. Therefore, potential barriers to the successful implementation of the UDDS should be assessed prior to implementation. The findings of this investigation contribute to further improving patient safety and increasing efficiency in the hospital system.