The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study.
BACKGROUND
Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting. In this study we aimed to explore hospital inpatients' involvement with medication safety-related behaviours, facilitators and barriers to this involvement, and the impact of electronic prescribing.


METHODS
We conducted ethnographic observations and interviews in two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during our study. Researchers and lay volunteers observed nurses' medication administration rounds, pharmacists' ward rounds, doctor-led ward rounds and drug history taking. We also conducted interviews with healthcare professionals, patients and carers. Interviews were audio-recorded and transcribed. Observation notes and transcripts were coded thematically.


RESULTS
Paper or electronic medication records were shown to patients in only 4 (2%) of 247 cases. However, where they were available during patient-healthcare professional interactions, healthcare professionals often viewed them in order to inform patients about their medicines and answer any questions. Interprofessional discussions about medicines seemed more likely to happen in front of the patient where paper or electronic drug charts were available near the bedside. Patients and carers had more access to paper-based drug charts than electronic equivalents. However, interviews and observations suggest there are potentially more significant factors that affect patient involvement with their inpatient medication. These include patient and healthcare professional beliefs concerning patient involvement, the way in which healthcare professionals operate as a team, and the underlying culture.


CONCLUSIONS
Patients appear to have more access to paper-based records than electronic equivalents. However, to develop interventions to increase patient involvement with medication safety behaviours, a wider range of factors needs to be considered.
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, United Kingdom.|Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, United Kingdom.
Sara
S
Garfield
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, United Kingdom.
Seetal
S
Jheeta
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, United Kingdom.
Fran
F
Husson
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, United Kingdom.
Jill
J
Lloyd
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, United Kingdom.
Alex
A
Taylor
Patients' Participation Group, Walm Lane Surgery, London, United Kingdom.
Charles
C
Boucher
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, United Kingdom.
Ann
A
Jacklin
Pharmacy Department, Chelsea and Westminster Healthcare NHS Foundation Trust, London, United Kingdom.
Anna
A
Bischler
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, United Kingdom.|King's College London, Faculty of Nursing & Midwifery & Imperial College Healthcare NHS Trust, London, United Kingdom.
Christine
C
Norton
Meeting of Minds, London, United Kingdom.|Collaborative Leadership in Applied Healthcare Research Northwest London, London, United Kingdom.
Rob
R
Hayles
Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, United Kingdom.|Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, United Kingdom.
Bryony Dean
BD
Franklin
D011307:Drug Prescriptions; D055695:Electronic Prescribing; D006282:Health Personnel / Q000523:psychology; D006761:Hospitals; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008508:Medication Errors / Q000523:psychology*; D010358:Patient Participation / Q000523:psychology*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010607:Pharmacy Service, Hospital / Q000379:methods; D036301:Qualitative Research; D012449:Safety
D004364:Pharmaceutical Preparations