title: Who Do Hospital Physicians and Nurses Go to for Advice About Medications? A Social Network Analysis and Examination of Prescribing Error Rates.
abstract: OBJECTIVE
  To measure the weekly medication advice-seeking networks of hospital staff, to compare patterns across professional groups, and to examine these in the context of prescribing error rates.
  
  
  METHODS
  A social network analysis was conducted. All 101 staff in 2 wards in a large, academic teaching hospital in Sydney, Australia, were surveyed (response rate, 90%) using a detailed social network questionnaire. The extent of weekly medication advice seeking was measured by density of connections, proportion of reciprocal relationships by reciprocity, number of colleagues to whom each person provided advice by in-degree, and perceptions of amount and impact of advice seeking between physicians and nurses. Data on prescribing error rates from the 2 wards were compared.
  
  
  RESULTS
  Weekly medication advice-seeking networks were sparse (density: 7% ward A and 12% ward B). Information sharing across professional groups was modest, and rates of reciprocation of advice were low (9% ward A, 14% ward B). Pharmacists provided advice to most people, and junior physicians also played central roles. Senior physicians provided medication advice to few people. Many staff perceived that physicians rarely sought advice from nurses when prescribing, but almost all believed that an increase in communication between physicians and nurses about medications would improve patient safety. The medication networks in ward B had higher measures for density, reciprocation, and fewer senior physicians who were isolates. Ward B had a significantly lower rate of both procedural and clinical prescribing errors than ward A (0.63 clinical prescribing errors per admission [95%CI, 0.47-0.79] versus 1.81/ admission [95%CI, 1.49-2.13]).
  
  
  CONCLUSIONS
  Medication advice-seeking networks among staff on hospital wards are limited. Hubs of advice provision include pharmacists, junior physicians, and senior nurses. Senior physicians are poorly integrated into medication advice networks. Strategies to improve the advice-giving networks between senior and junior physicians may be a fruitful area for intervention to improve medication safety. We found that one ward with stronger networks also had a significantly lower prescribing error rate, suggesting a promising area for further investigation.
authors.affiliation: From the *Clinical Redesign and Decision Support Unit, St Vincent's Hospital, Darlinghurst, and †Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia.
authors.forename: Nerida
authors.initials: N
authors.lastname: Creswick
authors.forename: Johanna Irene
authors.initials: JI
authors.lastname: Westbrook
mesh_terms: D000328:Adult; D006748:Hospital Departments / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D008505:Medical Staff, Hospital; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D009517:New South Wales; D009741:Nursing Staff, Hospital; D004364:Pharmaceutical Preparations; D012944:Social Support
chemical_list: D004364:Pharmaceutical Preparations