Challenges and barriers associated with medication management for home nursing clients in Australia: a qualitative study combining the perspectives of community nurses, community pharmacists and GPs.

Abstract

Increasing numbers of older people are receiving home nursing support for medication management to enable them to remain living at home. Home nursing clients frequently experience medication errors and adverse medication events. There has been little study of how medication management processes and interdisciplinary teamwork impact on medication management in the home nursing setting. To explore medication management processes and describe barriers and challenges from the perspective of community nurses, community pharmacists and GPs involved in the provision of medication management services for home nursing clients. Focus groups, in-depth interviews and stakeholder consultations were conducted with a convenience sample of community nurses, community pharmacists and GPs. Data were analysed using the framework approach (a deductive thematic analysis) to identify issues affecting the delivery of medication management services. Ten focus groups, 12 in-depth interviews and 5 stakeholder consultation meetings were conducted with 86 health practitioners (55 community nurses, 17 GPs, 10 community pharmacists and 4 nurse managers). Participants highlighted a range of barriers and challenges associated with medication management for home nursing clients, including deficiencies in interdisciplinary communication; problems related to organizational or workplace policies, processes and systems; and ineffective team function. The negative impacts of these were recognized as compromised client safety, reduced workforce efficiency and productivity and compromised interprofessional relationships. Barriers and challenges with medication management for home nursing clients and associated negative impacts were identified. Strategies are needed to improve interdisciplinary medication management and medication safety in the home nursing setting.