Aim(s)To synthesize aged care provider, resident and residents' family members' perspectives and experiences of medication administration in aged care facilities; to determine the incidence of medication administration errors, and the impact of medication administration on quality of care and resident‐centredness in aged care facilities.DesignA mixed‐methods systematic review. PROSPERO ID: CRD42023426990.Data SourcesThe AMED, CINAHL, MEDLINE, EMBASE, EMCARE, PsycINFO, Scopus and Web of Science core collection databases were searched in June 2023.Review MethodsIncluded studies were independently screened, selected and appraised by two researchers. The Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) checklist was followed, with the Mixed Methods Appraisal Tool was used for critical appraisal. Convergent synthesis of data, thematic synthesis and meta‐analysis were performed.ResultsOne hundred and twenty‐eight studies were included (33 qualitative, 85 quantitative and 10 mixed‐methods). Five themes were formulated, including 1) Staffing concerns, 2) The uncertain role of residents, 3) Medication‐related decision‐making, 4) Use of electronic medication administration records and 5) Medication administration errors. Educational interventions for aged care workers significantly reduced medication administration errors, examined across five studies (OR = 0.37, 95%CI 0.28–0.50, p < .001).ConclusionsMedication administration in aged care facilities is challenging and complex on clinical and interpersonal levels. Clinical processes, medication errors and safety remain focal points for practice. However, more active consideration of residents' autonomy and input by aged care workers and providers is needed to address medication administration's interpersonal and psychosocial aspects. New directions for future research should examine the decision‐making behind dose form modification, aged care workers' definitions of medication omission and practical methods to support residents' and their family members' engagement during medication administration.Implications for the profession and/or patient careIt is important that medication administration in aged care facilities be more clearly acknowledged as both a clinical and interpersonal task. More attention is warranted regarding aged care workers clinical decision‐making, particularly concerning dose form modification, covert administration and medication omissions. Resident‐centred care approaches that support resident and family engagement around medication administration may improve adherence, satisfaction and quality of care.ImpactWhat Problem Did the Study Address? Medication administration in aged care facilities is a complex clinical and interpersonal activity. Still, to date, no attempts have been made to synthesize qualitative and quantitative evidence around this practice. There is a need to establish what evidence exists around the perspectives and experiences of aged care workers, residents and resident's family members to understand the challenges, interpersonal opportunities and risks during medication administration.What Were the Main Findings? There is a lack of empirical evidence around resident‐centred care approaches to medication administration, and how residents and their families could be enabled to have more input. Dose form modification occurred overtly and covertly as part of medication administration, not just as a method for older adults with swallowing difficulties, but to enforce adherence with prescribed medications. Medication administration errors typically included medication omission as a category of error, despite some omissions stemming from a clear rationale for medication omission and resident input.Where and on Whom Will the Research Have an Impact?The findings of this systematic review contribute to aged care policy and practice regarding medication administration and engagement with older adults. This review presents findings that provide a starting point for aged care workers in regards to professional development and reflection on practice, particularly around clinical decision‐making on dose form modification, medication administration errors and the tension on enabling resident input into medication administration. For researchers, this review highlights the need to develop resident‐centred care approaches and interventions, and to assess whether these can positively impact medication administration, resident engagement, adherence with prescribed medications and quality of care.Reporting MethodThis systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (Page et al., 2021).Patient or Public ContributionNo patient or public contribution to this systematic review.

中文翻译：

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老年护理机构的药物管理：混合方法系统评价


目的 综合老年护理提供者、居民和居民家庭成员对老年护理机构药物管理的看法和经验；以确定药物管理错误的发生率，以及药物管理对老年护理机构的护理质量和以居民为中心的影响。设计混合方法系统评价。 PROSPERO ID：CRD42023426990。数据来源于2023年6月检索AMED、CINAHL、MEDLINE、EMBASE、EMCARE、PsycINFO、Scopus和Web of Science核心合集数据库。综述方法纳入的研究由两名研究者独立筛选、选择和评价。遵循系统评价和荟萃分析（PRISMA）清单的首选报告项目，并使用混合方法评估工具进行严格评估。对数据进行收敛综合、主题综合和荟萃分析。结果纳入 128 项研究（33 项定性研究、85 项定量研究和 10 项混合方法研究）。制定了五个主题，包括 1) 人员配备问题、2) 住院医师的不确定角色、3) 药物相关决策、4) 电子药物管理记录的使用和 5) 药物管理错误。对老年护理人员的教育干预显着减少了用药错误，五项研究对此进行了检验（OR = 0.37，95%CI 0.28–0.50， p < .001)。结论老年护理机构的药物管理在临床和人际层面上具有挑战性且复杂。临床流程、用药错误和安全仍然是实践的焦点。 然而，需要更积极地考虑居民的自主权以及老年护理人员和提供者的投入，以解决药物管理的人际和社会心理方面的问题。未来研究的新方向应检查剂型修改背后的决策、老年护理人员对药物遗漏的定义以及支持居民及其家庭成员参与药物管理的实用方法。对专业和/或患者护理的影响重要的是，老年护理机构的药物管理应被更明确地视为一项临床和人际任务。需要更多关注老年护理人员的临床决策，特别是剂型修改、秘密给药和药物遗漏。支持居民和家庭参与药物管理的以居民为中心的护理方法可以提高护理的依从性、满意度和质量。影响该研究解决了什么问题？老年护理机构的药物管理是一项复杂的临床和人际活动。尽管如此，迄今为止，尚未尝试综合这种做法的定性和定量证据。有必要围绕老年护理人员、住院医师和住院医师家庭成员的观点和经验建立哪些证据，以了解用药过程中的挑战、人际机会和风险。主要发现是什么？关于以居民为中心的药物管理护理方法以及如何让居民及其家人获得更多投入，缺乏经验证据。 作为药物管理的一部分，剂量形式的修改公开或秘密地发生，不仅仅是作为吞咽困难的老年人的一种方法，而且是为了强制遵守处方药物。药物管理错误通常包括药物遗漏作为错误类别，尽管有些遗漏源于药物遗漏和住院医师投入的明确理由。研究将在何处以及对谁产生影响？本系统评价的结果有助于老年护理政策以及有关药物管理和与老年人接触的实践。本综述提出的研究结果为老年护理工作者在专业发展和实践反思方面提供了一个起点，特别是在剂型修改、药物管理错误以及让居民参与药物管理方面的临床决策方面。对于研究人员来说，本综述强调需要制定以住院医师为中心的护理方法和干预措施，并评估这些方法和干预措施是否可以对药物管理、住院医师参与、处方药物依从性和护理质量产生积极影响。 报告方法本系统评价是根据系统评价和荟萃分析的首选报告项目（Page 等人，2021）。患者或公众贡献 本系统评价没有患者或公众贡献。