Abstract
Objectives
The objectives of this study were (1) to investigate the effect of nurse training
on the use of potentially harmful medications; and (2) to explore the effect of nurse
training on residents' health-related quality of life (HRQoL), health service utilization,
and mortality.
Design
A randomized controlled trial.
Setting and participants
In total, 227 residents in 20 wards of assisted living facilities in Helsinki were
recruited. The 20 wards were randomized into those in which (1) staff received two
4-hour training sessions on appropriate medication treatment (intervention group),
and (2) staff received no additional training and continued to provide routine care
(control group).
Intervention
Two 4-hour interactive training sessions for nursing staff based on constructive learning
theory to recognize potentially harmful medications and corresponding adverse drug
events.
Measurements
Use of potentially harmful medications, HRQoL assessed using the 15 dimensional instrument
of health-related quality of life, health service utilization, and mortality assessed
at baseline, and 6 and 12 months.
Results
During the 12-month follow-up, the mean number of potentially harmful medications
decreased in the intervention wards [−0.43, 95% confidence interval (CI) −0.71 to −0.15]
but remained constant in the control wards (+0.11, 95% CI −0.09 to +0.31) (P = .004, adjusted for age, sex, and comorbidities). HRQoL declined more slowly in
the intervention wards (−0.038 (95% CI −0.054 to −0.022) than in the control wards
(−0.072 (95% CI −0.089 to −0.055) (P = .005, adjusted for age, sex, and comorbidities). Residents of the intervention
wards had significantly less hospital days (1.4 days/person/year, 95% CI 1.2–1.6)
than in the control wards (2.3 days/person/year; 95% CI 2.1–2.7) (relative risk 0.60,
95% CI 0.49–0.75, P < .001, adjusted for age, sex, and comorbidities).
Conclusions
Activating learning methods directed at nurses in charge of comprehensive care can
reduce the use of harmful medications, maintain HRQoL, and reduce hospitalization
in residents of assisted living facilities.
Keywords
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Article info
Publication history
Published online: May 08, 2014
Footnotes
Dr Pitkälä reports having professional cooperation including lecturing fees from pharmaceutical and other health care companies (including Lundbeck, Orion), and having participated in clinical trials funded by pharmaceutical companies. Dr Juola, Dr Kautiainen, Dr Soini, Dr Finne-Soveri, Dr Bell, and Dr Björkman have no competing interests. This study is supported by Sohlberg Foundation and Helsinki University Hospital development grant.
Trial registration: ACTRN12611001078943.
The authors declare no conflicts of interest.
Identification
Copyright
© 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
