Researcher Information

To begin, I would like to introduce myself: My name is PhDr. Bc. Marcel Tóth. Based on my own multi-year work experience in nursing management abroad, I decided to create an innovative project – the Drug Administration Monitoring System (hereinafter referred to as "MSDL"), a web portal www.msdl-mojelieky.sk, www.davkovacliekovmsdl.sk. The MSDL project focuses on medication use, contributing to the reduction of possible errors such as overdosing or underdosing long-term sick clients living in social service facilities, senior centers, Social Service Centers, and for clients living in their home environment. I have had the opportunity to visit several social service facilities not only in Slovakia but also abroad, and I have realized that our seniors have the same rights as seniors beyond our borders.

Everyone has the right to health protection. On the basis of health insurance, citizens have the right to free health care and health aids under conditions established by law." Article 40 of the Constitution of the Slovak Republic

Limits and Possibilities of Social Service Management Associated with the Performance of Certain Professional Activities

The goal of the MSDL research is to improve nursing care in social service facilities in Slovakia, in the form of pharmaceutical care for recipients of social services. The goal of the MSDL research is to create and improve drug management for social service facilities in Slovakia in the area of improving nursing care, in the form and preparation of drugs, in the area of administering drugs to recipients of social service facilities. Another target group of MSDL are elderly clients living in their home environment, who are at high risk of overdosing or underdosing when taking medication. The goal of the MSDL research is to improve communication between professional workers in social service facilities, but also with external professional health workers.

The main task of MSDL is to improve drug management in social service facilities in Slovakia.

MSDL simplifies drug auditing by the head nurse in social service facilities. MSDL prevents the reuse of a client's medication when treatment has already been terminated by either a general or specialist doctor. It also increases safety in the preparation, administration and use of medication by clients, as many seniors have a large number of prescribed medications. MSDL saves administrative time for nurses in social service facilities. It also reduces the risk of errors in drug preparation and administration – overdosing or underdosing a client with medication. Similarly, it reduces the time-consuming nature of nursing work in preparing and administering medication in social service facilities.

Thanks to the MSDL project, practical nurses will also be able to administer medication to clients in these facilities, as medications will be prepared by nurses in social service facilities. Thanks to MSDL, archiving of a client's medication records will be simplified, etc.

In connection with the global process of population aging, the importance of geriatric pharmacotherapy issues has increased. The specifics of pharmacotherapy in older age result from the morphological and functional differences typical of the aging organism. Prescribing medication for patients over 65 years of age requires an individual approach, taking into account a number of factors that can influence the final effect of pharmacotherapy (physiological aging, age-related pharmacokinetic and pharmacodynamic changes, polymorbidity, polypharmacotherapy, impaired adaptation of the organism, non-compliance, adverse effects and drug interactions). The fundamental problems in geriatric prescribing are polypharmacy, or excessive use of medication, or conversely, underdosing or inappropriate prescribing. Since there are several categories of potentially inappropriate prescribing, evaluating pharmacotherapy in a specific patient requires a comprehensive approach.

According to statistics, more than 630,000 people over 65 years of age live in Slovakia, of which about 272,000 are over 75 years old. Approximately one third live in social service facilities. Based on research by the Ministry of Health of the Slovak Republic, I found that the Slovak Republic spends nearly 1 billion euros on drug purchases and 650,000 euros on their disposal.

We know that people of retirement age have various diagnoses and a large number of prescribed medications associated with them, which leads to polypharmacy in the patient. Polypharmacy means that a patient has five or more drugs prescribed per day.

Based on our long-term professional research in the field of drug management in various social service facilities in Slovakia, I found that these facilities do not have quality drug management and nurses are under time stress when preparing and administering individual medications to clients.

There is a high risk that a nurse may make a mistake in preparing or administering medication, or may give the wrong dose to a client. I found that in many facilities, medications are prepared by the night nurse, a process that can take up to 7 hours. This means that she spends 7 hours dosing medication for about 60 clients in the facility the day before, so they are ready for administration the next day.

According to our findings and information, during these 7 hours, approximately 490 individual tablets pass through the nurse's hands, and this is only for about 60 clients, because elderly clients have a large number of prescribed medications, from both general and specialist doctors. This time could be spent by the nurse on clients or other professional activities.

We also found that some social service facilities prepare medications for clients in artificial drug dispensers for 7 days, which poses a risk that anyone could handle those medications. Based on professional research from abroad, it has been proven that artificial pill bottles are not good for storing medications, as medications lose their therapeutic molecular efficacy after 72 hours in them.

We further found that nurses lose a lot of time recording medications in clients' nursing records, whether in paper or electronic form. We verified that there is no continuous and clear monitoring of medication use by clients in social service facilities in Slovakia. All medications prescribed by a doctor are written manually, which is a high risk of causing errors in dosing or administering medication.

In social service facilities, there is a lot of medication waste, and there is poor feedback communication with pharmacists or the clients' attending physicians. Consequently, this leads to the client being exposed to the risk of various drug allergies. Based on our practical experiences in Slovakia, we have also encountered situations where emergency responders came to examine a client and we had difficulty determining whether the medication had been terminated by a doctor or whether the client's dosage had been changed.

Currently, there is a severe shortage of professional health personnel in social service facilities, leading to unqualified staff preparing and administering medication, which is a high risk to the client's health status.

Therefore, we propose and offer a solution in the form of an innovative project Drug Administration Monitoring System (MSDL) in community nursing care for clients living in social service facilities and clients living in their home environment in Slovakia.

The innovative MSDL project is focused on improving nursing care in social service facilities in Slovakia in the preparation and administration of medication for long-term sick clients, reducing errors caused by nurses in administering medication, continuous monitoring of medication use, reducing clients' allergic reactions to medication, saving time for health personnel in these mentioned facilities, reducing nurse stress, reducing administrative work for nurses, safe administration of medication to clients and safe and easy transfer of medication within the facility, easy archiving and easy access to patient medication information, reducing health insurance costs for medication payment, reducing health insurance costs for client hospitalization, reducing health insurance costs for emergency responder dispatches to these facilities, and saving state funds for medication disposal, etc.

In Slovakia, eHealth – the electronic health card of the patient – already exists, where the patient's doctor can quickly familiarize themselves with the patient's health status and what medications were prescribed in the past and currently. It is a great positive step for Slovakia that it launched an electronic health monitoring system and continuous patient treatment. Another positive aspect of healthcare is the existence of electronic prescription, and patients can choose medications at any pharmacy in Slovakia.

We see a very real opportunity for change in the provision of nursing care in our country, based on new facilities that strive to provide care of higher quality. It is not so important how a facility is furnished, but what its employees can provide, what rights are important to respect, and above all, that the client is always in first place and their interests, their previous life, etc., must be respected.

FEEDBACK

I want to thank you for coming up with something as amazing as this MSDL project to protect our seniors, and I am proud that you managed to implement it in a way that is accessible and attractive for all categories of long-term sick clients in social facilities and those living in the home environment in Slovakia. Statement of the respondent

One of the goals of the research project msdl-mojelieky.sk is to raise awareness of drug management in social facilities and the safe administration of medication to recipients of social services in Slovakia. As part of the research project MSDL, a seminar was organized for pharmacists, nurses and practical nurses in social facilities in the Bratislava, Žilina, and Trenčín regions. Some pharmacies and social facilities in the mentioned regions received a MSDL drug dispenser as a sponsorship for testing from the implementer of the MSDL project. The value of the MSDL sponsorship donation – the drug card and packaging aids – amounted to 8,750 euros.

Other employees from social facilities (caregivers, educators, psychologists, etc.) also participated in the research project. The seminar participants learned about our innovative MSDL research project.

After completing the seminar, all participants gained sufficient knowledge, skills and work tools to be able to safely prepare and administer medication for long-term sick clients living in social facilities.

Therefore, after a certain period of time after completing the seminar and using the MSDL drug dispenser (drug card), we approach the participants with a questionnaire for feedback. In addition to evaluating the seminar, we are interested in how they assess the situation in terms of preparing and administering medication for long-term sick clients living in social facilities and subsequently the use of the new MSDL tool in the prevention of medication errors in dosing and administration to clients, etc.

MSDL SEMINAR PARTICIPANTS

By September 1, 2020, 296 out of 316 participants in the MSDL seminar had completed the questionnaire. Most participants were pharmacists, nurses, practical nurses and caregivers. Specifically, there were 145 nurses, 85 practical nurses, 24 pharmacists, 22 caregivers, 12 educators and 8 psychologists. They were most often employees of social facilities (specifically from 13 senior centers) and social service homes (specifically from 10 social service homes). For the MSDL research – drug card, 23 social facilities were used, 9 social service facilities from the Bratislava region, 6 social service facilities from the Žilina region, and 8 social service facilities from the Trenčín region. It involved 405 clients from 23 social facilities. 405 clients received 4 MSDL drug cards per month, which represents 1,620 MSDL drug cards.

EVALUATION OF THE SEMINAR AND MSDL – DRUG CARD msdl-mojelieky.sk

The vast majority of MSDL seminar participants evaluate it as interesting and consider the information gained to be very useful. According to the participants, the MSDL seminar is of high quality, engaging and very current; it would be meaningful, in their opinion, if all employees in social facilities, as well as relatives of clients living in social facilities, completed it. They appreciate that the MSDL seminar was not only theoretical but also included practical demonstrations and case studies from real life about unintentional overdosing or underdosing with medication, which even led to hospitalization of the client.

Several participants would welcome more time for similar training, and thus more space for discussion. As part of follow-up training, they would be interested in deepening topics, especially regarding the issue of polypharmacy and its prevention in long-term sick clients living in social facilities in Slovakia.

EVALUATION

LIMITS AND POSSIBILITIES OF SOCIAL SERVICE MANAGEMENT ASSOCIATED WITH THE PERFORMANCE OF CERTAIN PROFESSIONAL ACTIVITIES

To the question of whether the MSDL – drug management topic was presented in an interesting way, 198 respondents answered "very interesting," representing 66.89%. 97 respondents answered "completely interesting," representing 32.77%, and 1 respondent answered "neither interesting nor uninteresting," representing 0.34%.

Graph 1 Was the topic presented in an interesting way?

To the question of whether respondents knew what drug management in social community care is, only 6 respondents answered that they knew about drug management, representing 4.14%; 132 respondents answered that they did not have such knowledge, representing 91.03%; and 7 respondents had not heard of it, representing 4.83%.

Graph 2 Did you know what drug management in social community care is?

To the question of what method of medication preparation is used in the social service facility, 17 respondents answered that they prepare them once a week for their clients, representing 73.91%, and 6 respondents answered that they prepare medications four times a day, representing 26.09%.

Graph 3 What method of medication preparation do you use in your facility?

The question focused on the method of medication dispensing showed that 6 social service facilities use Petri dishes for dispensing medications, representing 26.09%, and 14 social service facilities use artificial 7-day drug dispensers, representing 60.87%. Medications are administered directly from the original packaging by 13.04%.

Graph 4 What do you dispense medications into for your clients?

To the question of how much time nurses spend preparing medications for 60 clients, 6 respondents answered that it takes them 120 minutes, representing 4.14%; 12 respondents answered 180 minutes, representing 8.27%; 95 respondents answered 240 minutes, representing 65.51%; and 32 respondents answered that it takes a very long time, representing 22.08%.

Graph 5 Nurses, how much time do you spend preparing medications for 60 clients?

To the question of whether nurses considered the training in the use of the MSDL system to be difficult, 144 respondents answered "no," representing 99.31%, and only one respondent answered "yes," representing 0.69%.

Graph 6 Was the training for nurses in the use of the MSDL system – MSDL drug card difficult?

To the question of how much time is needed to pack medications for 60 clients into the MSDL – drug card, 122 respondents answered that it takes them 80 minutes, representing 84.13%, and 23 respondents answered 120 minutes, representing 15.86%. From this, it clearly follows that the MSDL drug card saves nurses time.

Graph 7 Nurses, how much time do you spend preparing medications for 60 clients into the MSDL – drug card?

To the question of how nurses rate packing medications into the MSDL – drug card, 128 respondents answered that they are "very satisfied," representing 88.27%; 12 respondents answered that they are "satisfied," representing 8.27%; 3 answered "less dissatisfied," representing 2.08%; and 2 respondents are "dissatisfied," representing 1.38%. Pharmacists responded that they are "satisfied" with the MSDL – drug card in 5 cases, representing 20.83%, and 19 respondents answered that they are "very satisfied," representing 79.17%.

Graph 8 Evaluation of nurses and pharmacists regarding packing medications into the MSDL – drug card

To the question of how clients of social service facilities evaluated the MSDL – drug card, we obtained the answer that as many as 365 clients are "extremely satisfied" with the MSDL drug card, representing 90.12%; 33 are "very satisfied" clients, representing 8.15%; 5 are "less satisfied," representing 1.23%. One client expressed dissatisfaction, representing 0.25%, and also one client will not use the MSDL drug card, representing 0.25%.

Graph 9 Evaluation of MSDL project clients and use of the MSDL drug card

To the question of whether our respondents think that the MSDL – drug card is safe, both for clients and for employees working in social service facilities, 294 respondents answered "of course yes," representing 99.33%, and 2 respondents answered that they "cannot express an opinion," representing 0.67%.

Graph 10 Do you think the MSDL – drug card is safe for clients and employees of social service facilities?

To the question of whether social service facilities would accept the use of the MSDL – drug card as part of drug management in their social service facility, 19 respondents answered "yes," representing 79.17%; 1 respondent answered "no," representing 4.16%; 4 respondents answered "don't know," representing 16.67%; and 24 pharmacists would certainly welcome it, representing 100%.

Graph 11 Would you like to include packing medications into the MSDL – drug card for social service facilities among your services?

Regarding the question about the advantages of the MSDL – drug card from the perspective of nurses and directors of social service facilities, nurses answered from their perspective and from the perspective of directors of social service facilities that the advantages are:

  • Fast preparation of medications.
  • Prepared medications cannot be tampered with.
  • Simple and transparent drug audit.
  • The therapeutic component of the drug does not leak, meaning the drug has 100% efficacy.
  • Minimal occurrence of medication errors in drug preparation.
  • Simple overview of medications prescribed by the doctor.
  • When a nurse packs medications into the MSDL – drug card, medications can also be administered by a practical nurse or caregiver.
  • Client safety with regular medication use.
  • Clients maintain independence in administering and taking medications.
  • Rapid information about client's drug therapy for the multidisciplinary team.

Suggestions and Recommendations for Practice

As has been demonstrated in the research part of our work, interest in using the MSDL – drug card and using drug management in senior centers and social service homes is influenced by social and economic factors, which are dynamic, and frequent lack of interest in innovative approaches to drug intervention and therapy in senior centers and social service homes, which are influenced by socio-economic factors. Two-factor theory, social and socio-economic factors significantly contributed to the understanding and comprehension of interest in using innovative approaches in client treatment in community care in social services.

The Drug Administration Monitoring System is a major benefit for social facilities, where the practical significance is identified in providing nursing and social services to long-term sick clients in pharmaceutical nursing care. We confirm this fact with the results of our research. Great interest on the part of social facilities in using drug management and preparing medications for 7 days into the MSDL – drug card.

The expected output and benefit of the MSDL – drug card for everyday practical life is the measurement and evaluation of the degree (rate) of interest with interest factors and total interest in using the MSDL – drug card in senior centers and social service homes.

Through our research, we emphasized that interest in using the MSDL – drug management and its placement in senior centers and social service homes, as part of the overall life satisfaction of a senior, is significant not only in terms of their subjective experience of the autumn of life but undoubtedly also affects their current health and mental state, emotional mood, self-confidence, ability to resist stress and support active engagement in solving problematic situations, which in turn affects the quality of life in senior centers and social service homes.

At the same time, we arrived at the result regarding which factors respondents attribute the greatest importance to; this creates space for implementing measures in practice that would allow reducing or eliminating their lack of interest in placement in senior centers and social service homes.

The research results are applicable to both employees in managerial positions in state and public institutions, directors of social facilities, and supervisors in multiple areas of their operation.

They can serve as a starting point for creating such working conditions that health professionals can prioritize their mission, have enough space to listen to clients, propose, and also implement the most appropriate solutions for social clients placed in senior centers and social service homes.

Through the analysis of interest in placing seniors in senior centers and social service homes, we brought a perspective for nursing professionals from a different angle than as representatives of a profession whose primary mission is help and support.

This is the first research conducted in Slovakia in the field of social and nursing services and their significance for clients within the Bratislava, Žilina, and Trenčín regions, which we carried out in such a way that results could be compared: a statistical perspective to show changes and development. The main contribution of this scientific research activity was the exploration and documentation of the field of social and nursing services and their significance for clients, its preservation and presentation. This scientific research activity in the field of social and nursing services and their significance for clients pushes the boundaries of knowledge of drug management in every area, and its results will undoubtedly contribute to the elevation and resolution of the given issue on a scientific basis, both at the theoretical and practical levels.

The material obtained and analyzed through research will be a rich source of knowledge in providing social and nursing services and their significance for clients in general and in all areas of life and societal development.

Our research results also demonstrated that increasing interest in placing the MSDL in senior centers and social service homes cannot be achieved by measures focused exclusively on socio-economic factors or exclusively on health and social factors.

It is desirable to focus efforts so that both external and internal factors are represented in all areas of seniors' lives. Managers can utilize the research results and, based on these findings, their task is to create appropriate conditions and a supportive environment for seniors.

Interest as a set of nursing and social factors for placement in a senior center or social service home can also be supported because they contain a motivational aspect, which is associated only with positive emotional experience.

With the intention of achieving a good return rate for the questionnaire, we created closed questions and omitted open questions in the questionnaire to avoid burdening respondents and discouraging them from giving it sufficient attention and answering honestly. We conducted our research in a different time zone than the one in which the two-factor theory originated.

Authors: PhDr. Bc. Marcel Tóth The author is a doctoral student at the University of Health and Social Work of St. Elizabeth in Bratislava PhDr. Libuša Repiská, PhD. MPH Doc. Andrea Gallová, PhD.

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