Improving post-hospital medication management in a Danish municipality: A process evaluation

AIMS AND OBJECTIVES: This study evaluates an intervention developed to improve patient safety in post-hospital medication management carried out by visiting nurses working in a municipality in Denmark. The intervention consisted of three elements: an initial inter-disciplinary home visit by nurses, two subsequent scheduled visits, and the use of an organising tool.

BACKGROUND: As a consequence of specialised treatment plans and new treatment possibilities, patients with complex care needs can now be discharged from hospital more rapidly - and in greater numbers - than previously. Medication management is identified as the most challenging component of a discharge from the hospital to the home, in which discrepancies have been found in up to 94% of medication lists.

DESIGN: A process evaluation inspired by the UK Medical Research Council's guidance.

METHODS: The process evaluation was conducted for three months in a visiting nurses department. Data consisted of visiting nurses' self-reports of performance of the intervention and group interviews (n=4) with visiting nurses (n=14). Self-reports were analysed to evaluate implementation performance and elaborated with interview data to illuminate mechanisms of impact and contextual factors.

RESULTS: The implementation of the intervention highlighted the importance of the nurse-patient relationship, nursing assessment and logistics, and professional values in post-hospital medication management. Complex care needs were a mediator in the high implementation rate, which involved 31 out of the 38 patients in the target group.

CONCLUSION: For patients with complex care needs, post-hospital medication management may be improved by a reconsideration of the activity-based funding of home healthcare, a recognition of the importance of organising work and a critical consideration of standard systems. This article is protected by copyright. All rights reserved.