title: A qualitative systemic analysis of drug dispensing in Swiss hospital wards.
abstract: OBJECTIVE
  The traditional floor stock drug distribution system entails that, in most Swiss hospitals, drugs are prepared in a pillbox for each patient by nurses before administration. The aim of this study was to analyse and evaluate the process of inpatient pillbox dispensing in Switzerland.
  
  
  METHODS
  Internal medicine wards in three regional hospitals (32-39 beds).
  
  
  METHODS
  A qualitative exploratory study with 4 days of participant observation and three semi-structured interviews on each of the three wards.
  
  
  METHODS
  Thematic content analysis of observations, casual conversations and semi-structured interviews.
  
  
  RESULTS
  Pillboxes are prepared in a somewhat tumultuous context. The space for preparation is not isolated from health carers' other activities which makes it prone to numerous interruptions. Drug blisters and tablets often lack the necessary inscriptions to identify them as unit doses. Storage places are small and unstructured. Nurses have to translate medical orders into the name and dosage of the hospital formulary drugs. Use of patients' own drugs hampers both storage and preparation. Nurses take easily a task over one from another, which affects continuity. Practices vary and few standard rules have been set. The position of nurses in the medication process makes them routinely compensate for failures and gaps from healthcare workers involved in the upper stream of their tasks, without any opportunity of giving some feedback.
  
  
  CONCLUSIONS
  The preparation of a pillbox is error prone not only because single doses of oral drugs are not identifiable in a safe way, but also because of various context-related factors. The latter can be grouped into four categories that are linked in a dynamic relationship: tools, practices, organization and information transmission. Improvement strategies should consider all four categories as well as the specific position of nurses in the medication process which makes them fundamental guarantors of the system resilience.
authors.affiliation: Pharmacie des Hôpitaux du Nord Vaudois et de la Broye, Entremonts 11, 1400 Yverdon-les-Bains, Switzerland. amina.gadri@phnvb.ch
authors.forename: Amina
authors.initials: A
authors.lastname: Gadri
authors.forename: Renaud
authors.initials: R
authors.lastname: Pichon
authors.forename: Georges L
authors.initials: GL
authors.lastname: Zelger
mesh_terms: D003627:Data Interpretation, Statistical; D004349:Drug Packaging; D006748:Hospital Departments / Q000706:statistics & numerical data*; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D008509:Medication Systems / Q000706:statistics & numerical data*; D009726:Nurses; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010865:Pilot Projects; D015203:Reproducibility of Results; D013557:Switzerland; D013607:Tablets
chemical_list: D013607:Tablets