A Nurse Manager Is Reviewing a Clients Medical Record and Discovers That the Client Received

• Journal List
• J Multidiscip Healthc
• v.thirteen; 2020
• PMC7608001

J Multidiscip Healthc. 2020; 13: 1347–1361.

The Role of the Nurse in the Direction of Medicines During Transitional Intendance: A Systematic Review

Abbas Mardani

¹Nursing Care Research Center, Schoolhouse of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran

Pauline Griffiths

ⁱⁱSection of Nursing, College of Human and Health Sciences, Swansea University, Swansea, Wales, Britain

Mojtaba Vaismoradi

ⁱⁱⁱFaculty of Nursing and Health Sciences, Nord University, Bodø, Norway

Received 2020 Aug 7; Accepted 2020 Sep 4.

Abstract

Purpose

To synthesise noesis and to explore the role of the nurse in medicines management during transitional care.

Methods

An integrative systematic review was conducted. Electronic databases such every bit PubMed [including Medline], Web of Cognition, Scopus, and Cinahl from January 2010 to April 2020 were searched. Original qualitative and quantitative studies written in English that focused on the role of the nurse in medicines management during transitional care, which included movement betwixt short-term, long-term, and community healthcare settings were included.

Results

The search procedure led to the retrieval of 10 studies, which were published in English from 2014 to 2020. They focused on the role of the nurse in patients' medicines management during transitional care in various healthcare settings. Given variations in the aims and methods of selected studies, the review findings were presented narratively utilizing three categories adult past the authors. In the first category as 'medication reconciliation process' the nurse participated in obtaining medication history, performing medication review, identifying medication discrepancies, joint medication reconciliation and adjustment. The second category as 'collaboration with other healthcare providers' highlighted the nurses' part in clarifying medicines' concerns, interdisciplinary advice and consultation, discharge planning and monitoring. In the third category as 'provision of support to healthcare recipients', the nurse was responsible for interpersonal communication with patients, education nearly medicines, and simplification of medication regimens, and symptoms management during transitional care.

Determination

Nurses play a crucial office in the safety of medicines management during transitional care. Therefore, they should be empowered and more involved in medicines direction initiatives in the healthcare system. Patient safety and avoidance of medication errors during transitional care require that medicines management becomes a multidisciplinary collaboration with constructive communication between healthcare providers.

Keywords: continuity of care, multidisciplinary collaboration, medicines direction, nurse, patient rubber, systematic review, transitional care

Introduction

Transitional care has become an important aspect of patient care in the healthcare system due to shorter lengths of hospital stay and the increased requirements of post-discharge care.¹ Given the clan between patient handovers during transitional intendance and incidences of agin events, transitional intendance has been identified every bit a loftier-risk phase of the patient intendance journey.^{ii – 4} Transitional care has been defined as a set of developed measures to ensure the continuity and coordination of wellness care when the patient is transferred betwixt various levels of health care in the same or to other healthcare settings.^{5 , 6} The transfer of necessary information and the liability of patient care from one healthcare setting to some other is the fundamental and essential chemical element of quality and rubber in healthcare facilities.⁷ Factors that can disrupt effective transitional care across healthcare settings include inadequate patient or caregiver training, inappropriate communication between healthcare providers, insufficient evaluation of admission to medication, and depression wellness literacy levels.⁸ Therefore, transitional care has become a concentrated surface area of research and practice in medical sciences.^ix

Transitional Intendance: Medicines Management and Patient Safety

Achieving optimal transitional care between healthcare settings is essential to ensure patient safe and prevent hospital readmissions.¹⁰ It has been suggested that effective transitional intendance can reduce by l% the relative run a risk of readmission within 30 days of discharge and save $2 for every $1 spent in the healthcare system.¹¹ In general, transitional care programmes piece of work equally the bridge betwixt pre-discharge and post-discharge caring interventions at multiple points in time. Patient engagement, besides every bit collaboration and communication between healthcare staff,¹² is encouraged from access to the primary intendance setting to the return to the patient's own home.¹³

Medicines management is an essential component of the provision of loftier-quality care and patient safety in transitional care.¹⁴ 1 of the main solutions for patient rubber from the perspective of the Earth Wellness Arrangement (WHO) is to ensure medication safety in transitional intendance.¹⁵ Also, medication-related bug take been considered to be substantial components of high-quality care in transitional care,¹⁶ in detail, that the medication regimen be transferred equally safely as possible.¹⁷ Transitional intendance programmes tin help with reducing medication-related problems, improving admission to medication therapy, providing comprehensive medication counselling, and bridging gaps in medication care post-obit infirmary belch.¹⁰ However, patients in transitional care betwixt healthcare settings are decumbent to medication errors due to the lack of appropriate communication betwixt healthcare providers, insufficient didactics and training, inappropriate follow-upward, inadequate medication reconciliation, and lack of engagement of patients and their family caregivers in medicines management.¹⁸ Preventable adverse drug events in transitional intendance account for 46%–56% of all medication errors.¹⁹ A systematic review reported that 11%-59% of the medication history errors at admission and discharge had the potential to harm the patient.^twenty Redmond et al²¹ in a Cochrane review on 20 studies reported that 559 out of thou patients were at the take a chance of one or more medication discrepancies during standard transitional care programmes. Points of care transition in the healthcare arrangement where patients are at the danger of medication-related harm include hospital to home transition;²² admission to the hospital;²³ infirmary admission, transfer and discharge;²⁴ belch from the hospital and post-discharge;²⁵ and admission to the emergency department.²⁶

Effective medicines management is a complex undertaking in both brusk-term and long-term healthcare settings including hospitals and nursing homes and requires collaboration by healthcare providers such as nurses, physicians and pharmacists to maximize positive healthcare consequences and to minimize practice errors.¹⁴ Medicines direction is one of the nigh complex interdependent clinical challenges in health intendance and each healthcare provider involved in transitional intendance has independent, articulation and overlapping responsibilities.^{27 , 28} Nurses are considered to be cardinal members of the transitional care team.^{29 , 30} Their crucial role encompasses evaluating the transitional care programme, recognizing potential problems and and so resolving them in social club to improve patient condom.³¹ Involvement of nurses in medicines management of transitional care helps with the provision of access to treat patients with fragmented care or those at high hazard of readmission. Their role has been suggested to be an alternative to the utilize of emergency services because information technology improves the workflow for referring physicians and supports care navigation back to community healthcare providers through patient teaching and medication self-management.³²

Despite the importance of nurse participation in the safety of medication practice and the success of transitional care, there is no integrated knowledge of the nurse role in medicines management of transitional care in the international literature. Therefore, this systematic review of the international literature aimed to find an reply to the following question: What is the function of the nurse in medicines management during transitional care?

Aim

This review aimed to synthesise knowledge and explore the part of the nurse in medicines management during transitional care.

Methods

Protocol and Registration

This integrated systematic review of international literature involved both qualitative and quantitative studies.^{33 – 35} It allowed the authors to combine individuals' understandings obtained from statistical findings of quantitative research and narrative findings of qualitative studies in order to develop a comprehensive understanding of the written report phenomenon.³⁶ This systematic review was informed of the Preferred Reporting Items Systematic Reviews and Meta-analysis (PRISMA) Argument³⁵ and has been registered on the PROSPERO under the code of CRD42020163046: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=163046.

Search Process and Eligibility Criteria

To place appropriate keywords, the research squad undertook discussions amongst themselves and likewise drew upon their experiences in the field of transitional care and medicines management. They too conducted a airplane pilot search in full general and specialized databases to find relevant keywords. To identify papers on the role of the nurse in medicines management during transitional intendance, the Boolean search method was applied using the following keywords: (nurs* AND (participation OR interest OR engagement OR role) AND ("transitional care" OR "transition of intendance" OR "care transition" OR "healthcare transition" OR "continuity of patient care") AND ("medicines management" OR medication OR medicines OR drug OR "pharmaceutical preparations" OR pharmaceuticals)). Guidance and support were received from an expert librarian during the search process. Appropriately, the online databases of PubMed [including Medline], Web of Knowledge, Scopus and Cinahl were searched to extract studies published in online peer-reviewed scientific journals from Jan 2010 to April 2020. Grayness literature search encompassed policy documents, clinical guidelines and cross-references from bibliographies for improving the search coverage. Inclusion criteria for selecting relevant studies were: qualitative and quantitative studies, focus on the role of the nurse, medicines management of transitional care in short-term and long-term healthcare settings as well every bit community healthcare settings, and publication in peer-reviewed scientific journals. Articles without exact relevance to the nurse's role or concentration on the part of other healthcare professionals involved in medicines direction were excluded.

Written report Selection

Each step of the systematic review process was performed independently past the authors (AM, PG and MV). They undertook online conversations to share the search results and decide on the adjacent steps of the study. The studies' titles, abstracts and full-texts were obtained during the search procedure and were screened by the authors. The authors held discussions to resolve controversies and accomplish a consensus over the inclusion of selected studies.

Quality Appraisement

For the overall quality appraisal of selected studies in terms of the appropriateness of the inquiry process and construction, the Enhancing the Quality and Transparency of Health Research (EQUATOR) was used.³⁷ Tools for the appraisal of selected studies were as follows: the Standards for Reporting Qualitative Enquiry (SRQR) for qualitative research; the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for observational, cross-sectional and accomplice studies; the Good Reporting of A Mixed Methods Report (GRAMMS) for Mixed-methods designs; Consolidated Standards of Reporting Trials (CONSORT) for experimental and quasi-experimental studies. Too, the Hawker et al³⁸ criteria regarding the research aim, scientific structure, quality of the research process and methodology, determination and references were peculiarly considered for appraising the studies. In addition to the consideration of scores given by the appraisal tools for making a final decision on the inclusion or exclusion of studies, the authors discussed and made advisable decisions on the significance and the methodological quality of each report for information analysis and synthesis.

Data Drove Process and Synthesis of Results

A data extraction table, containing the commencement author surname, publication year, the country where the study was conducted, design, sample size and setting, and information relating to the role of the nurse in medicines management of transitional care were developed and pilot-tested to ensure that information technology could collect required information on the characteristics of selected studies. The review findings were presented narratively due to variations within the selected studies in terms of aims and methods that hindered performing a meta-analysis. The results of the selected studies were and so reviewed and advisable categories were developed based on differences and similarities in their findings. The authors undertook frequent discussions to reach agreements on assigning the studies' findings into the categories.

Results

Search Outcome and Selection of Studies

The results of our search in the databases accept been presented in Table 1. The search process using the predetermined keywords led to retrieving 4037 articles. After deleting unrelated and indistinguishable titles, and performing abstruse and total-text reading, x studies were selected finally for data assay and synthesis. The methodological quality of the selected studies was evaluated during the total-text appraisal phase. No report was excluded as it was judged that they had an acceptable level of quality in terms of presentation and research design, theoretical and conceptual framework, and their findings could inform our review. No more studies were discovered for inclusion during the grey literature search and from reviewing the reference lists of the selected studies.

Tabular array 1

Results of Dissimilar Phases of the Search Procedure

Database	Full in Each Database	Selection Based on Title Reading	Option Based on Abstruse Reading	Pick Based on Full-Text Reading/Appraisal
CINAHL	1012	xiv	four	2
PubMed [including Medline]	2283	13	four	3
Scopus	570	6	2	i
Web of Science	172	eleven	4	4
Manual search/backtracking references	0	0	0	0
Total of databases	4037	44	fourteen	10

The study flow diagram according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) has been presented in Effigy 1.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Note: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med half-dozen(7): e1000097. Available from: http://prisma-statement.org/PRISMAStatement/FlowDiagram.aspx. The PRISMA Statement distributed nether the terms of the Creative Commons Attribution License.⁶⁵

General Characteristics of the Selected Studies

An overview of the selected studies (n = 10) has been demonstrated in Tabular array 2. They were all published in English from 2014 to 2020, seven studies were from the USA,^{39 – 45} one from Canada,⁴⁶ one from Oman,⁴⁷ and one from Commonwealth of australia.⁴⁸

Tabular array two

Characteristics of the Studies Selected for Data Analysis and Synthesis

Authors, Year, Land	Aim	Method/Full-Text Appraisal Score	Sample and Setting	The Function of the Nurse in Medicines Management During Transitional Intendance	Principal Finding
Vogelsmeier, 2014, USA45	To explore the perceptions of leaders and staff nurses of nursing homes apropos the process of medication reconciliation, with a focus on recognizing the medication gild discrepancies	Qualitative/17 out of 21	18 leaders, 13 registered nurses, and 28 licensed practical nurses in 8 mid-western nursing homes	Main role in medication reconciliations and a main role in identifying discrepancies in the medication order	Nursing dwelling physicians rely on nurses to know almost medicines; active vs passive data seeking in medication history and diagnosis of discrepancies; making sense of medication orders to recognize discrepancies
Chan et al, 2015, Canada46	To compare the completeness and accurateness of best possible medication histories and reconciliation performed by a chemist's shop technician (pilot study) and past nurses and/or pharmacists (baseline)	Prospective cohort comparison/25 out of 34	84 patients upward to 18 years admitted to and/or transferred between the cardiac critical intendance unit of measurement and cardiology unit of measurement of a paediatric third care didactics hospital	Transfer of medication reconciliation through obtaining best possible medication histories	No differences betwixt the nurse and/or pharmacist and pharmacy technician in terms of the completion of all-time possible medication histories or completion of reconciliation inside 24h of admission; transfer reconciliation completeness was higher in the chemist's technician than nurse and/or chemist
Manias et al, 2015, Australia48	To explore how healthcare providers, patients, and their family members communicate about managing medicines across transitional care points	Qualitative/eighteen out of 21	x patients, 10 family members, 27 nurses, 15 pharmacists and xi physicians from two public hospitals	Clarifying medicines' concerns and patients' clinical parameters with doctors; nurses situated in the nursing abode organize medicines' changes with a phone phone call to a general practitioner in the infirmary when a patient transfers to the nursing domicile; performing interpersonal communication with patients and interdisciplinary advice was crucial for medicines management	Major themes: contextual environs of care, competing responsibilities of intendance, awareness of responsibleness for safe, and interprofessional advice
Lovelace et al, 2016, The statesforty	To investigate the impact of the McGuire veterans assistants medical centre transitional care program on veteran emergency section and hospital utilization and costs	Retrospective review of medical records/24 out of 34	346 veterans from the Richmond, VA Hunter Holmes McGuire VAMC as a 399-bed facility	An initial cess including an all-encompassing medication review, collaboration with the pharmacist to provide an authentic belch medication nautical chart, making medication adjustments and order medications' renewals	Veterans who received transitional care program services had a 67% reduction in infirmary admissions and a 61% reduction in emergency section visits in the ninety days subsequently participation in the program
Reidt et al, 2016, USA43	To describe the interprofessional collaborative practice model and compare the outcomes of participants who received intendance based on the model and those individuals who received routine care from the geriatrician and nurse practitioner in transition from the skilled nursing facility to home	Experimental/24 out of 37	87 participants in the intervention group received care based on the model, and 189 individuals in the comparison grouping received routine intendance at a non-profit skilled nursing facility with sixty transitional care unit beds	Provision of consultation to the pharmacist when unexplained changes occurred in the effectiveness of and safety of all prescriptions, collaborating with the pharmacist to determine the discharge medication regimen, and recommending items to the pharmacist to address at follow-ups	At that place was no departure in hospitalizations 30 days afterward discharge from the skilled nursing facility; participants receiving the intervention according to the model had a lower risk of emergency department visits
Al-Hashar et al, 2017, Sultanate of oman47	To investigate beliefs, responsibilities and perceived roles of nurses, pharmacists and physicians almost the medication reconciliation process	Survey/eighteen out of 32	143 physicians, 47 pharmacists and assistant pharmacists and 274 nurses from a university tertiary care hospital with 450 beds	Nurses had a joint role with physicians and pharmacists in medication reconciliation in transitional intendance	A lack of clearness of current practices of medication reconciliation and a lack of agreement about other providers' function in medication reconciliation betwixt the three healthcare professions
Chhabra et al, 2019, USA39	To compare time spent past nurses and pharmacists according to the location of a medication-focused interview	Prospective, unblinded, accomplice observational/26 out of 34	72 patients were randomized based on the location of chemist to be interviewed in the emergency department or on the flooring in a 435-bed community infirmary	Collecting medication history and performing medication reconciliation with admitting physicians	Pharmacists and nurses spent a hateful of 10 minutes less per patient in the emergency section than patients on the medical floor for collecting medication history. The discrepancy in the transcript was found by the rate of ane in four medications
Otsuka et al, 2019, USA41	To examine the outcome of an interprofessional transition of care facility on 30-twenty-four hour period hospital reutilization	Retrospective cohort/28 out of 34	660 patients were in the interprofessional mail-astute care clinic every bit in the intervention group and the comparison group from two outpatient clinics within an academic medical middle.	Performing the follow-upwards call to the patient or caregiver to brainstorm the procedure of medication reconciliation past determining if patients were capable to make full their new prescriptions	thirty-day infirmary readmission was lower in the intervention grouping, but for emergency department visits no difference between the groups was plant
Tjia et al, 2019, Us44	To identify nurses' viewpoints well-nigh their function in hospice family unit caregivers' medication management	Secondary qualitative analysis/fifteen out of 21	6 home hospice nurses, 3 inpatient hospice nurses, and 1 medical dwelling house nurse coordinator for principal care from three hospice agencies and their referring infirmary systems	Performing medication review as the central component of medication support and deprescribing procedure, providing education to increase medication knowledge to family unit caregivers, simplifying medication regimens equally support to patient and family caregivers	Instruction, skill-building, back up and counselling for family caregivers; need to an intervention to standardize patient-cantered medication review
Prusaczyk et al, 2020, USA42	To observe the transitional intendance measures provided to older adults with and without dementia	Mixed methods/v out of 6	9 healthcare providers in the qualitative stage and reviewing 126 patients with dementia and 84 without dementia from an urban, large academic medical heart with 9000 employees	Primary provision of instruction near medications, medication condom and being highly involved in medication reconciliation and medication review	Healthcare providers at the hospital had distinguished roles in the provision of transitional care to patients with different roles for patients with and without dementia

Regarding the studies' methodologies, ii studies used a qualitative design,^{45 , 48} one was a secondary qualitative assay,⁴⁴ one was a survey,⁴⁷ i used an experimental blueprint,⁴³ two used a prospective accomplice,^{39 , 46} one was a retrospective cohort,⁴¹ one used a mixed-method study,⁴² and one was a retrospective review of medical records.^forty

Transitional Signal of Care in the Selected Studies

The selected studies focused on medicines management during the transition of care in various settings as follows: from the emergency department to the medical ward, ³⁹ from the hospital to the long-term intendance facilities and home,⁴² from the hospital to dwelling house,^{40 , 41} betwixt different wards in the hospital,⁴⁶ from the skilled nursing facility to dwelling house,⁴³ from the access to discharge at the hospital,⁴⁷ from the emergency department to discharge,⁴⁸ to a dwelling hospice,⁴⁴ and to a nursing dwelling.⁴⁵

The Function of the Nurse in Medicines Management During Transition of Care

Since there were heterogeneities in the studies' methods, objectives and results, a meta-analysis could not be conducted and our review findings were presented narratively. Iii categories concerning the role of the nurse in the safety of medicines management of transitional care were identified: "medication reconciliation process", "collaboration with other healthcare providers", and "provision of support to healthcare recipients". These categories were identified subsequently an analysis of the studies' findings (Figure 2).

The nurse role in medicines management of transitional care.

Medication Reconciliation Process

This category discusses the function of the nurse in the medicines' cess process during transitional care at diverse healthcare levels. Nurses were noted to play a crucial role in medicines management through the reconciliation procedure, where an authentic list of a patient'southward electric current medicines was assessed and was compared with the electric current list in apply. Appropriately, the nurses had three main responsibilities as "cess of medication history", "identification of medicines discrepancies", and "articulation role in medicines reconciliation" that were described as follows.

Assessment of Medication History

Nurses were involved in obtaining medication history from patients in the admission time to healthcare centres or at the transition between healthcare levels.^{39 , 46} Chhabra et al³⁹ noted that clinical nurses were involved in the medication reconciliation process at access. Accordingly, emergency nurses collected medication history, and albeit floor (ward) nurses collected additional medication history and sent the study nigh medication reconciliation to admitting physicians. The mean time spent past albeit floor nurses collecting medication history prior to (11 minutes) or later on (sixteen.six minutes) placing the admission orders were not significantly different, but time spent per medication afterward placing admission orders (two minutes) was college than before information technology (0.94 minute). In the study by Chan et al⁴⁶ the nurses' role in the medication reconciliation procedure was to obtain the all-time possible medication history and perform medication reconciliation for those patients who were admitted to the cardiology ward or the critical care unit of measurement or those who were transferred between wards.

Identification of Medicines Discrepancies

Reviewing medications overall,^{40 , 42} collecting data for identifying medication discrepancy,⁴⁵ and medication support and deprescribing procedure⁴⁴ were reported equally roles of nurse. In the transitional care plan devised by Lovelace et al^forty the instance management nurse performed an initial assessment and extensive medication review during the start home visit or phone follow-up after discharge from the infirmary. The outpatient nurse practitioner then collaborated with the case direction nurse during domicile visits. They reviewed medications according to the assessment provided past the case management nurse, made adjustments, and ordered medications renewals if the example management nurse faced difficulties in admission to primary healthcare providers. Prusaczyk et al⁴² described transitional intendance measures being provided to older adults with and without dementia in the transition from the hospital to long-term care facilities and home, and noted that registered nurses and avant-garde practice registered nurses delivered medication safely to 99% and 37% of patients, respectively. Advanced practice registered nurses were described equally being highly involved in medication review and medication reconciliation.

In the study by Tjia et al,⁴⁴ nurses' perspectives on their role in family caregivers' medicines direction and support in transition to dwelling hospice were addressed. Nurses considered that medication review was a cardinal component of medication support and the deprescribing process. The nurse was responsible for checking the medication list to find essential and nonessential medicines, describing them to the family caregiver and discussing with the md to receive recommendations on discontinuing nonessential ones to prevent side effects, adverse drug reactions (ADRs), and polypharmacy. The nurse would also monitor the procedure of medication by the patient and the family caregiver earlier making whatsoever decision regarding changes to essential medicines.

Vogelsmeier⁴⁵ reports that nurses in nursing homes had a chief office in performing medication reconciliations and they assessed medication history and identified medication order discrepancies during transition to nursing homes. Some nurses performed "active information seeking" through reviewing transfer documents and talked with residents and families in guild to empathise the medication history and reasons behind ordering medications. Others performed "passive information seeking" equally they causeless that medication orders at transfer were correct and that fourth dimension challenges and heavy workloads hindered deciphering clinical information to detect medication society discrepancies. Many nurses did engage in a cerebral process called "sense-making" where tried to identify medication discrepancies. In this respect, rules/regulations, specific medications and the feel of errors and adverse events were cues to consider potential discrepancies.

Joint Role in Medicines Reconciliation

In the study past Otsuka et al⁴¹ nurses were the members of interprofessional mail service-acute care clinics and were involved in medicines management for those patients who were transferred from the hospital to their ain homes. The process of medication reconciliation was started through assessing patients' capabilities to fill up out their new prescriptions via phone calls to the patient or the caregiver within ii business concern days post discharge.

Al-Hashar et al⁴⁷ reported that nurses had a supportive role working with pharmacists and physicians in medication reconciliation from hospital admission to discharge. Nurses considered themselves to be 2nd only to physicians in medication reconciliation since they: obtain an accurate medication history on admission, verify and reconcile discrepancies between the medication history list, those ordered on admission and at transition, and send the discharge medication list to the side by side healthcare provider. Nurses considered that they were second only to the pharmacist in the provision of instructions and counselling for patients about medications upon discharge. From the pharmacists' perspective, the nurses' role in the procedure of medication reconciliation was of less importance than that of pharmacists and physicians as nurses were not involved in sending the patients' belch medication list to the next healthcare provider. Physicians described the nurse playing a supportive function in the medication reconciliation procedure with key roles being played by themselves and the chemist in the medication reconciliation in transitional care.

Collaboration with Other Healthcare Providers

This category describes the role of the nurse in the medicines management of transitional intendance at various healthcare levels in collaboration with other healthcare providers. In the study by Manias et al⁴⁸ regarding communication virtually medicines direction during the transition indicate between emergency departments and medical wards, the nurses' proactive stance in medical wards was axiomatic as nurses clarified concerns over medicines with doctors. Nurses in the medical ward evaluated the clinical parameters of transferred patients from the emergency department and alerted doctors about gathered information leading to rational medicine changes. When the patient was transferred to the nursing dwelling, those nurses then organized medicines' changes via a phone call to the general practitioner.⁴⁸

Diverse synchronous and asynchronous forms of interdisciplinary communication amidst healthcare professionals including nurses, physicians, and pharmacists influenced medicines management betwixt the transition points of care.⁴⁸ While nurses considered verbal communication essential so as to be equipped speedily to provide suitable intendance, asynchronous advice, such every bit discharge summaries and referral letters, was also valued. The accurateness and readability of the documented content of communication were pregnant requirements to avoid medication discrepancies at transitional points of care. Nurses acknowledged that written communication was essential to face the challenge of working in a rapidly changing environment.⁴⁸

In the study by Lovelace et al⁴⁰ some patients were transferred to nursing homes for short-term rehabilitation post-obit their hospitalizations based on the devised transitional care programme. The pharmacist contacted the nursing home to obtain a list of belch medications and sent the list and information to the case management nurse who and so contacted the patients or their caregiver to schedule a abode visit. Following the abode visit, case management nurses would then report medication discrepancies to the members of the transition care programme team and the patients' primary intendance provider and intendance director. The case direction nurse would also collaborate with a pharmacist to provide a precise discharge medication chart with print size adjustments for those patients suffering from dumb vision.

Vogelsmeier'south⁴⁵ study plant that nursing home physicians relied on information and recommendations provided by the nurse to know what medications the resident was supposed to be taking considering they provided care to residents only in the nursing home. The physicians were unfamiliar with residents' medical care prior to transfer, rarely communicated with other healthcare providers and were non present at the time of transfer. Therefore, nurses were the prime number source of information on medicines direction and would request that the doctor perform required assessments and review laboratory values. The nurse would and so consult with the physician prior to medicines being prescribed.

Reidt et al⁴³ focussed on a model for interprofessional collaboration that improved discharge from a skilled nursing facility to dwelling. Nurses played the master role in discharge planning from the skilled nursing facility. The chemist a few days before belch would review the electronic health tape to evaluate dietary supplement prescriptions and over-the-counter medications in terms of indication, effectiveness and safety and would ensure that changes of medications made during the hospital and skilled nursing facility stays were still appropriate. The pharmacist resolved unexplained changes by consulting with the nurse practitioner and shared recommendations such as starting or ceasing medicines, adjusting doses, or ensuring that necessary laboratory work was ordered for the discharge medication regimen. In addition, the chemist and nurse determined collaboratively the discharge medication regimen. The nurse also monitored item medicines' side effects and reminded patients near follow-upwards appointments.

Provision of Back up to Healthcare Recipients

This category discusses the nurses' provision of back up to healthcare recipients in the medicines management of transitional intendance at various healthcare levels. Tjia et al⁴⁴ explored nurses' perspectives on their role in family caregivers' medicines management and support in the transition to abode hospice. Nurses provided education and skill edifice for family caregivers, and emphasized increasing cognition and teaching regarding symptoms. To enable skill-edifice, they focused on symptom management and less on medicines system and assistants. The medication regimen was simplified for patients' and family caregivers past eliminating as many medications as possible.⁴⁴ Nurses also improved trust and communication through paying attention to patients and their family caregivers and understanding the concerns of the family caregiving when deprescribing medications.⁴⁴

Prusaczyk et al⁴² evaluated transitional intendance interventions provided by various healthcare providers to older adults with and without dementia in transition from the infirmary to long-term intendance facilities and dwelling house. Nurses were the principal providers of patient educational activity regarding medication education and how to manage and monitor symptoms later discharge. Advanced practitioner registered nurses also helped with didactics almost the management and monitoring of symptoms. In the Al-Hashar et al⁴⁷ written report, nurses described their key role in the provision of instructions and counselling to patients about medications upon discharge. Manias et al⁴⁸ described interpersonal communication between wellness professionals, including nurses, and patients beingness the key ingredient of maintaining medication safety. Provision of medicines' instructions for patients when moved between their homes and the hospital meant patients could take a more agile stance in managing their medicines.

Discussion

This systematic review integrated the findings of qualitative and quantitative studies and synthesised noesis regarding the function of the nurse in the safety of medicines management of transitional care. Findings from this review signal that the nurse'southward role in medicines management of transitional encompasses: medication reconciliation, collaboration with other healthcare providers, and provision of support to healthcare recipients. According to the international literature, all healthcare professionals should collaborate together to ensure patient safety. Moreover, nurses should take more responsibility and become more than involved in patient rubber initiatives and deed proactively in gild to protect and maintain the prophylactic of medicines' direction through disclosing and reporting errors.⁴⁹ In addition, nurses are able to be involved in the reduction of medicines' side furnishings and ADRs through monitoring medicines and providing informational support to doctors, pharmacists, patients and their families every bit well every bit applying fundamental nursing interventions to relieve potentially negative consequences on patient wellbeing.^{50 , 51}

This review discovered that nurses actively played various roles in the medication reconciliation procedure such equally collecting medication history, reviewing medications, collecting information to identify medication discrepancies, coordinating medication support, and supporting the deprescribing process. They started the medication reconciliation process by assessing patients' capabilities to comply with their new prescriptions and engaging in their articulation role with pharmacists and physicians in medicines management from admission to the hospital until belch. The nurse was the primal health professional person in performing medication reconciliation in nursing homes. Nurses raised concerns over medicines prescribed past doctors, provided medication consultation to the pharmacist, assisted in collaboratively determined discharge medication regimes, and had interdisciplinary communication with physicians and pharmacists to ensure medication safety. They provided medication didactics, consultation and symptoms management associated with medications, helped with simplifying the medication regimen, and established interpersonal advice to ensure medication safety and support to healthcare recipients. The nurses' integral role in the medication reconciliation process in various transitional points of care has been supported by electric current international literature.^{1 , 52 , 53} Medication reconciliation is defined as an official process in which healthcare providers piece of work with patients to ensure the exact and complete transfer of medication information at the interfaces of intendance.⁵⁴ Several international patient safety organizations including the Institute for Health Improvement (IHI), the Joint Commission (TJC), and the World Health Organization (WHO) have acknowledged that medication reconciliation is pivotal to achieve medication prophylactic through identifying medication discrepancies, specially at transition care points.⁵⁵ Achieving optimal medication reconciliation requires the recognition of responsibilities and roles, interdisciplinary teamwork, proper communication, and better tracking and reporting of data to successfully incorporate the stages of medication reconciliation and ensure patient safety.^{54 , 56} On the other hand, healthcare professionals' insufficient knowledge of medicines management is one of the of import barriers to achieving optimal medication reconciliation.⁵⁷ Sufficient education and grooming are not provided to nursing students to do medication reconciliation. Therefore, at that place is an axiomatic need for training on the total medication reconciliation process and policy in clinical settings and the medication reconciliation process should exist covered in the degree education curriculum of nurses.⁵⁸

As highlighted in the findings of this review, two of the main roles of the nurse in medicines management during transitional care are communication and collaboration with other healthcare providers. Equally a role of an interdisciplinary team, nurses along with physicians and pharmacists tin play a crucial office in medicines management during transitions from one setting to another. The findings of Albert'southward⁵⁹ systematic review on transition-of-care models in patients with heart failure suggested that multi-professional teamwork, communication, and collaboration had fundamental roles in ensuring patient safe. Another contempo systematic review by Bethishou et al^threescore investigating the effectiveness of pharmacy-led continuity of care programmes indicated that the collaboration of the pharmacist with nurses in undertaking telephone calls to patients after discharge improved the quality and safety of care. Ensing et al's⁵² suggested that in the transition betoken of care and post-discharge, pharmacists were near likely to collaborate closely with nurses to meliorate patient intendance outcomes. Lack of communication and collaboration between healthcare providers, including nurses, is an important bulwark to medicines management at the transitional point of care.⁵⁷ Therefore, nurses should develop communication skills and effectively exist invited to collaborate with the interprofessional team in order to meliorate the continuity and coordination of care.^{61 , 62}

Our review findings indicate that the nurses' role in the provision of educational activity and support about medications and symptoms direction to patients and their family caregivers requires optimal communication to ensure medication prophylactic. Provision of patient support and education at the transition points of care tin reduce the take chances of adverse medication-related events.¹⁶ Ozavci et al⁶³ showed that medication discrepancies at transitional intendance of older patients were associated with nurses' advice with patients. A systematic review by Tobiano et al⁶⁴ on how patients engaged in medication communication during admission and discharge demonstrated that nurses performed counselling and teaching about medication, instructed patients almost the medication belch plan, and conducted telephone calls for post-hospital belch follow-ups about medications.

Limitations

The heterogeneity of the selected studies' methods and variations in their focus including beingness conducted in short-term and long-term healthcare settings might accept impacted the synthesis and integration of the review findings. Too, studies were express to English language. However, performing our search using multidimensional keywords and in international databases provided a comprehensive overview of the current international knowledge virtually the role of the nurse in medicines direction safe during transitional care. Also, bias in the procedure of data collection and synthesis was reduced as much equally possible through close cooperation and discussion between the authors. The function of nurses in medicines management during transitional care is closely related to the type of healthcare settings and blazon of transitional point of care. Given the limited number of studies that met the inclusion criteria for this review prevented the full exploration of the role of the nurse in medicines direction at different transitional points of care including transition within the hospital, from hospital to home and other healthcare facilities, which needs consideration in future studies.

Conclusion

This systematic review focused on the part of the nurse in medicines management during transitional care and identified how it impacted on patient safety. Both qualitative and quantitative research findings through an integrative review design were included in club to provide a comprehensive image of the study phenomenon.

Considering the disquisitional role of nurses in medicines direction during the transitional intendance process requires acceptable attention to degree level education and in-service training for nurses. Successful medicines management and reducing medication errors require the recognition of responsibilities and roles, a multidisciplinary collaboration and communication between diverse healthcare professions including nurses, doctors and pharmacists. Healthcare professionals through interdisciplinary collaboration and advice share objectives, brandish shared responsibleness and ability, make decisions collectively, and piece of work together to better medication safe during transitional care. Also, health professionals should exist aware of the office of the nurse in medicines management to ensure medication prophylactic during transitional intendance. Futurity studies using qualitative and quantitative research methods should explore how nurses can be more actively involved in medicines management of transitional care affecting on patient care outcomes including adherence to medication regimens, visits to the emergency department, and reduction of the readmission rate to long-term healthcare settings.

Acknowledgments

Nord Academy, Bodø, Kingdom of norway has supported the publication of this manuscript through coverage of publication charges.

Funding Statement

This research received no external funding.

Information Sharing Statement

All information pertinent to this study are independent in the commodity.

Writer Contributions

All authors made a significant contribution to the work reported, whether that is in the formulation, study design, execution, acquisition of information, assay and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be answerable for all aspects of the work. Information technology should exist mentioned that this article has been written in British English.

Disclosure

The authors have no conflicts of interest to declare.

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