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According to Thomas et al. (2019) polypharmacy is defined as the use of multiple or inappropriate medications especially in older adults with associated poor health outcomes. A dedicated outpatient training on polypharmacy is limited hence the need for enhanced training in geriatrics for future primary care providers. Improving medication safety involves collaborative effort. Thomas et al. (2019) conducted a study to assess post graduate residents’ knowledge of polypharmacy. Seventy four participants who were internal medical residents, nurse practitioners, pharmacists, pharmacist residents, primary care attendings and geriatric attendings were included in the study. The instrument used in the study to assess trainee knowledge of polypharmacy was a 26- item multichoice knowledge test designed by five clinicians experienced in addressing polypharmacy in the primary care setting. A consensus for use of the test was achieved through a modified Delphi process. Construct validity was determined using factor analysis and item response theory (IRT). The test was designed to yield one factor solution which was the knowledge of polypharmacy with emphasis on optimizing medication management of older adults living in the community.
Construct validity is the degree to which all aspects of a concept is measured by the instrument included. Factor analysis is the performed-on data collected from a scale of questionnaire. It examines the structure of the instrument which can vary between different populations (Connelly, 2019). In this study, the factor analysis confirmed the hypothesis that the test item developed will test the participants’ knowledge of polypharmacy. Parallel analysis was also used to confirm the hypothesis by statistically comparing randomly generated data with an average of over 1000 iterations. IRT was used in instrument validation. It enabled accurate examination of how well each test item showed participants’ ability level. In this study, the IRT analyzed each test taker and each test item individually to allow for selection of test items to generate the highest amount of information over the ability range (Thomas et al., 2019). The instruments used for this study were reliable based on the consensus achieved with a modified Delphi process. There was construct validity and factor analysis of the study hypothesis. It allowed for an objective approach with the process of selecting the number and identity of test items for the validated survey instrument used in the study. In addition, there was consistency and repeated data generated with item questions focused on one factor solution for the study aim which was to evaluate the knowledge of polypharmacy.
My Doctor of Nursing practice (DNP) quality improvement project will focus on medication review training to educate nurses in the long-term care facility on polypharmacy using the STOPP (Screening Tool of Older Persons’ Prescriptions) and Screening tool to Alert to Right Treatment (START) criteria as the measurement tool for the pilot study. The STOPP/START criteria is a validated tool that has been used in many studies to assess potentially inappropriate medications (PIMs) in older adults. It is the first physiological systems-based screening tool for potentially inappropriate drug therapy in older adults (Martin et al., 2018). A chart review will be conducted to determine the number of patients with polypharmacy, and a post chart review will be performed to determine if the medication training will decrease polypharmacy among older adults 65 years and above living in a long-term care facility.
References
Connelly, L. M. (2019). What is factor analysis? Medsurg Nursing, 28(5), 322-330. https://wilkes.idm.oclc.org/login?url=https://www.proquest.com/scholarly-journals/what-is-factor-analysis/docview/2306441086/se-2
Martin, H.J., Merino-Sanjuan,V., Peris-Marti,J., Correa-Ballester, M., Vial-Escolano, R., & Merino-Sanjuan, M. (2018). Applicability of the STOPP/START criteria to older polypathological patients in a long term care hospital. European Journal of Hospital Pharmacy, 25(6), 310-316. http://dx.doi.org/10.1136/ejhpharm-2017-001262
Thomas, J. M., Mecca, M. C., Niehoff, K. M., Mecca, A. P., Van Ness, P. H., Brienza, R., Hyson, A., & Jeffery, S. (2019). Development and validation of a polypharmacy knowledge assessment instrument. American Journal of Pharmaceutical Education, 83(5), 6435. https://doi.org/10.5688/ajpe6435
Respond to post below: According to Thomas et al. (2019) polypharmacy is defined
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