title: Communicating about the management of medications as patients move across transition points of care: an observation and interview study.
abstract: OBJECTIVE
  As patients move across transition points, effective medication management is critical for patient safety. The aims of this study were to examine how health professionals, patients and family members communicate about managing medications as patients moved across transition points of care and to identify possible sources of communication failure.
  
  
  METHODS
  A descriptive approach was used involving observations and interviews. The emergency departments and medical wards of two hospitals were involved. Observations focused on how health professionals managed medications during interactions with other health professionals, patients and family members, as patients moved across clinical settings. Follow-up interviews with participants were also undertaken. Thematic analysis was completed of transcribed data, and descriptive statistics were used to analyse characteristics of communication failure.
  
  
  RESULTS
  Three key themes were identified: environmental challenges, interprofessional relationships, and patient and family beliefs and responsibilities. As patients moved between environments, insufficient tracking occurred about medication changes. Before hospital admission, patients participated in self-care medication activities, which did not always involve exemplary behaviours or match the medications that doctors prescribed. During observations, 432 instances of communication failure (42.8%) were detected, which related to purpose, content, audience and occasion of the communication.
  
  
  CONCLUSIONS
  Extensive challenges exist involving the management of medications at transition points of care. Bedside handovers and ward rounds can be utilized as patient counselling opportunities about changes in the medication regimen. Greater attention is needed on how patients in the community make medication-related decisions.
authors.affiliation: School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia. emanias@deakin.edu.au.|Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia. emanias@deakin.edu.au.|Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia. emanias@deakin.edu.au.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
authors.affiliation: Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.|Emergency Department, The Royal Melbourne Hospital, Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Gerdtz
authors.affiliation: Monash Nursing Academy, Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
authors.affiliation: Pharmacy Department, The Alfred, Prahran, Victoria, Australia.|Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
authors.forename: Josephine
authors.initials: J
authors.lastname: McGuiness
authors.affiliation: Pharmacy Department, The Alfred, Prahran, Victoria, Australia.|Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Dooley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D017050:Episode of Care; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D054539:Medication Therapy Management; D008875:Middle Aged; D036301:Qualitative Research
keywords: communication; interprofessional care; interviews; medication management; observations; transitional care