Care home staff sense-making of medication management in care homes. An integrative theory of medication management derived through grounded theory

Dawodu, Patrick Ehichioya (2023) Care home staff sense-making of medication management in care homes. An integrative theory of medication management derived through grounded theory. Doctoral thesis, Northumbria University.

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Abstract

Background
Care home residents often experience high levels of frailty and multimorbidity, resulting in complex medication needs. The risk of medication errors is particularly pronounced in care homes due to inappropriate polypharmacy associated with multimorbidity. The challenges of inappropriate polypharmacy can lead to hospitalization and even death if not properly managed. Regular medication reviews by healthcare professionals are crucial, as emphasized by professional regulations. Therefore, a more comprehensive understanding of medication management systems (MMS) in care homes is necessary to enhance resident outcomes. However, limited research has focused on the perspective of care home staff, who play a vital role in direct care and medication management.

Method
This study employed a constructivist grounded theory framework and used semi-structured interviews, focus group interviews, and non-participant observation to collect qualitative data. Fifteen staff members from six care homes in four localities in Northeast England participated, including care home staff, and care home managers involved in medication management. The interviews and observations aimed to explore various topics, such as staff expectations of the MMS, the role of other healthcare professionals, facilitators and barriers in MMS, and the perception of care home staff regarding their role in medication management. Sequential data analysis led to the development of categories and, ultimately, a substantive theory.

Finding
Two key themes emerged from the analysis: 1) Care home staff challenges in navigating the medication management process; 2) Care home staff competence in medication management. The core category of integrative working was a common element in the findings. The core theory of integrative advantage in medication management highlighted the importance of integrating care home staff into a larger medication management ecosystem, enhancing their medication management experience. Collaboration and recognition of the roles and contributions of all stakeholders, including care home staff, are essential for successful medication management and improved resident care.

Conclusion
This study contributes to the growing recognition of the need for integrated healthcare delivery by enhancing the understanding of other healthcare professionals regarding the perspective of care home staff. It emphasizes the importance of competency and support for care home staff, acknowledges their abilities and limitations, and promotes better collaboration through improved communication that recognizes the role of care home staff in the medication management system. Additionally, this study provides evidence supporting integrative care in medication management from the perspective of care home staff, offering valuable insights for UK-based studies.

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