title: What is involved in medicines management across care boundaries? A qualitative study of healthcare practitioners' experiences in the case of acute kidney injury.
abstract: To examine the role of individual and collective cognitive work in managing medicines for acute kidney injury (AKI), this being an example of a clinical scenario that crosses the boundaries of care organisations and specialties.
  
  
  
  Qualitative design, informed by a realist perspective and using semistructured interviews as the data source. The data were analysed using template analysis.
  
  
  
  Primary, secondary and intermediate care in England.
  
  
  
  12 General practitioners, 10 community pharmacists, 7 hospital doctors and 7 hospital pharmacists, all with experience of involvement in preventing or treating AKI.
  
  
  
  We identified three main themes concerning participants' experiences of managing medicines in AKI. In the first theme, challenges arising from the clinical context, AKI is identified as a technically complex condition to identify and treat, often requiring judgements to be made about renal functioning against the context of the patient's general well-being. In the second theme, challenges arising from the organisational context, the crossing of professional and organisational boundaries is seen to introduce problems for the coordination of clinical activities, for example by disrupting information flows. In the third theme, meeting the challenges, participants identify ways in which they overcome the challenges they face in order to ensure effective medicines management, for example by adapting their work practices and tools.
  
  
  
  These themes indicate the critical role of cognitive work on the part of healthcare practitioners, as individuals and as teams, in ensuring effective medicines management during AKI. Our findings suggest that the capabilities underlying this work, for example decision-making, communication and team coordination, should be the focus of training and work design interventions to improve medicines management for AKI or for other conditions.
authors.affiliation: NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK.|Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, The University of Manchester, Manchester, UK.
authors.forename: Denham L
authors.identifier: 0000-0003-0857-2890
authors.initials: DL
authors.lastname: Phipps
authors.affiliation: NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK.|Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Morris
authors.affiliation: Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK.|NIHR Greater Manchester Collaborative for Leadership in Applied Health Reserach and Care, The University of Manchester, Manchester, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Blakeman
authors.affiliation: NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK.|Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, The University of Manchester, Manchester, UK.
authors.forename: Darren M
authors.initials: DM
authors.lastname: Ashcroft
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000628:therapy*; D004346:Drug Information Services; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D019317:Evidence-Based Medicine; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D010564:Personnel, Hospital; D010595:Pharmacists; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D036301:Qualitative Research; D013222:State Medicine; D016903:Drug Monitoring