(1111) Exploring Medication Conversations in Nursing Home Care Conferences: A Naturally Observed Qualitative Study

Objectives: Nursing home (NH) care plays a crucial role in the comprehensive care services offered to older adults. Current healthcare policy underscores the imperative for collaborative, team-based strategies in delivering person-centered care in NHs. Care conferences (also known as case conferences or multidisciplinary team meetings) can bring together NH staff, residents, and family members to discuss the resident’s goals of care, preferences, and health status, and agree on an individualized care plan. However, pharmacists rarely attend these conferences and collaborate with NH staff in residents' care planning. Given the paucity of research on pharmacist involvement and its impact on NH residents' care planning in care conferences, this study aimed to explore and describe medication conversations among NH staff, residents, and family members in care conferences without pharmacist participation, to identify potential opportunities for their involvement.

Methods: This qualitative study was conducted in a 40-bed, not-for-profit NH, primarily composed of short-stay residents, conveniently selected in the Midwest. Individuals eligible for enrollment in the study included NH staff, residents, and family members who met the following criteria: 1) aged 18 years or older; 2) were not legally incapacitated; and 3) were willing to participate. Data collection was conducted between March and May 2019. Observations of care conferences were audio recorded and transcribed verbatim. All transcripts were analyzed and classified inductively using content analysis with a focus on medication conversations among care conference attendees. Data were managed and analyzed using NVivo R1 software.

Results: A total of 15 care conferences, ranging between 20 and 55 minutes in length (with an average duration of 36 minutes), were observed. Of these, 14 (93%) included discussions about medications. The number of attendees in each care conference varied from 5 to 15, with the most frequent number being 6 (33.3%). Individuals in the care conferences encompassed residents, family members, social workers, registered nurses, physical, occupational, and speech therapists, dieticians, and certified nursing assistants. Pharmacists did not attend any care conferences. Medication conversations fall into one of the following 4 types: (1) Clinical Assessment—assessing therapeutic effects of medications, safety concerns, and residents' abilities to manage/administer medications; (2) Information Seeking/Information Sharing—reviewing or reporting on residents' medications and treatments, and exchanging medication-related information; (3) Decision Making—discussing or negotiating with residents and family members about introducing, modifying, or discontinuing medications or treatments; and (4) Discharge Planning—organizing the continuation of medications and identifying resources available to residents and family members for medication management post-discharge. Conversations about medication safety predominantly centered on potential bleeding and drug-drug interactions, especially concerning anticoagulants and analgesics. There were no discernible patterns identified when reviewing residents' medications. Topics and subtopics of medication conversations were brought up by NH staff based on their respective professions. The majority of these conversations were initiated by NH staff and were typically met with passive responses from both residents and family members.

Conclusions: NH residents often require complex medications, which can make them vulnerable to inappropriate medication use when planning to discharge home. Pharmacists can play an important role in NH care by providing services such as clinical medication review in collaboration with NH staff to optimize medication use and safety and provide medication management education prior to discharge. Findings from this study can enhance our understanding of how residents, family members, and NH staff communicate about medications. They also provide potential opportunities for pharmacists to participate in NH care planning. Several limitations of this study include the small sample size from a single facility, which primarily consisted of short-stay residents. Future research should explore patterns and needs among long-stay residents.