Medication safety in family caregiving of older adults: home visits including interviews, observations, and medication reviews

BACKGROUND: Family caregivers, as non-professionals, have a responsible and challenging task, especially with older care recipients with multiple illnesses and complex treatments, including medications. This can lead to preventable risks and medication errors which can harm the care recipients. OBJECTIVE: This study aimed to identify (1) medication safety risks, (2) medication errors, (3) contributing factors to the identified medication errors, and (4) the safeguards currently applied at home to avoid medication errors in family caregiving of older adults. METHODS: The qualitative study involved 21 officially contracted family caregivers and their older (≥ 65 years) care recipients who used ≥ 1 prescription medicine recruited from the capital area of Finland. The data were collected during two consecutive home visits using: (1) thematic interviews, (2) observations, and (3) medication reviews during the period of October 2017 to September 2018. The data were qualitatively content analyzed by applying a deductive approach. Human error theory with systems approach and prospective risk management was used as a theoretical framework. RESULTS: Medication safety risks and medication errors were found in all caregiving families. Most of the identified risks were related to administration, especially to characteristics of medications, medication taking techniques, behavior, and instructions. Medication errors occurred in storage, dispensing, administration, and follow-up. The most common identified medication errors were administration errors such as dose omission, wrong time, improper dose, and wrong duration. The most common contributing factors identified were related to administration errors. They included family caregiver-related factors (risky behavior), patient-related factors (e.g., behavioral factors such as non-compliance/non-adherence), organizational/service factors (e.g., medication use processes at home such as unsupervised medication taking), work/environmental factors (unlocked medication storage), and external factors (medication-related factors, lack of knowledge about medicines). As safeguards to prevent risks and medication errors, caregiving families commonly used pill dispensers, supervised medication taking, adjusted the medication taking schedule according to daily routines, used a cup to dispense medicines, and used a medication administration list. CONCLUSIONS: Medication safety risks and medication errors in family caregiving of older adults most related to the administration phase of the medication use process. Sufficient medicines information, information about medication management, up-to-date medication lists, locked medication storage, and enhanced pharmacists' involvement in patient and caregiver education could be among actions needed for improving medication safety at home in family caregiving of older adults.