Improving posthospital medication management in a Danish municipality: A process evaluation

Aims and objectives
To evaluate an intervention developed to improve patient safety in posthospital medication management carried out by visiting nurses working in a municipality in Denmark. The intervention consisted of three elements: an initial interdisciplinary 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 posthospital medication management. Complex care needs were a mediator in the high implementation rate, which involved 31 of the 38 patients in the target group.

Conclusion
For patients with complex care needs, posthospital medication management may be improved by a reconsideration of the activity-based funding of home health care, a recognition of the importance of organising work and a critical consideration of standard systems.