title: Complexities of medicines safety: communicating about managing medicines at transition points of care across emergency departments and medical wards.
abstract: OBJECTIVE
  To explore how health professionals, patients and family members communicate about managing medicines across transition points of care in two Australian public hospitals.
  
  
  BACKGROUND
  Medicines errors are common at transition points of care. Little qualitative work has targeted communicating about medicines management across patients' journeys from admission through to discharge.
  
  
  METHODS
  A qualitative descriptive study was undertaken.
  
  
  METHODS
  In-depth, semi-structured interviews were conducted with patients and family members, and focus groups and interviews were undertaken with doctors, nurses and pharmacists (n = 103). These individuals were situated in emergency departments and general medical wards. Data were analysed using thematic analysis.
  
  
  RESULTS
  Four themes were identified: contextual environment of care, competing responsibilities of care, awareness of responsibility for safety, and interprofessional communication. Contextual environment of care was affected by time pressure and efficiency, and an overriding priority to move patients out of emergency departments. In competing responsibilities of care, a reactive focus was displayed in emergency departments while a proactive stance was demonstrated in medical wards. There was an awareness of responsibility for safety, whereby key stakeholders appreciated the chain of events involved, interpersonal communication affected patients and carers, and consequences existed for patient education related to lack of information. Interdisciplinary communication was associated with communication modalities used in encounters, compartmentalised thinking, and medicines changes relayed to external providers.
  
  
  CONCLUSIONS
  Medicines management at transition points involved a complex interplay of dynamic features. This interplay infiltrated across diverse environments, affecting patient care within and outside hospitals.
  
  
  CONCLUSIONS
  Health professionals require greater appreciation of each other's roles at transition points of care. Prioritisation of high-risk patients is needed, such as those with cognitive impairment and multiple co-morbidities. Establishing workable protocols of communication etiquette and a structured approach to medicines activities may assist in pre-empting problems before they occur.
authors.affiliation: School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Vic., Australia; Melbourne School of Health Sciences, The University of Melbourne, Parkville, Vic., Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
authors.forename: Marie
authors.initials: M
authors.lastname: Gerdtz
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
authors.forename: Michael
authors.initials: M
authors.lastname: Dooley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003142:Communication; D004636:Emergency Service, Hospital; D005260:Female; D017144:Focus Groups; D006760:Hospitalization; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D036301:Qualitative Research; D000069341:Transitional Care; D055815:Young Adult
keywords: communication; family; interprofessional care; medicines management; nurses; patient; transitional care