Abstract
To identify the types and frequencies of communication issues (communication pairs, person related, institutional, structural, process and prescription-related issues) detected in medication incident reports and to compare communication issues that caused moderate or serious harm to patients. Communication issues have been found to be among the main contributing factors of medication incidents, thus necessitating communication enhancement. A sequential exploratory mixed-method design. Medication incident reports from Finland (n=500) for the year 2015 in which communication was marked as a contributing factor were used as the data source. Indicator phrases were used for searching communication issues from free texts of incident reports. The detected issues were analysed statistically, qualitatively and considering the harm caused to the patient. Citations from free texts were extracted as evidence of issues and were classified following main categories of indicator phrases. The EQUATOR's SRQR checklist was followed in reporting. Twenty-eight communication pairs were identified, with nurse-nurse (68.2%; n=341), nurse-physician (41.6%; n=208) and nurse-patient (9.6%; n=48) pairs being the most frequent. Communication issues existed mostly within unit (76.6%, n=383). The most commonly identified issues were digital communication (68.2%; n=341), lack of communication within a team (39.6%; n=198), false assumptions about work processes (25.6%; n=128) and being unaware of guidelines (25.0%; n=125). Collegial feedback and communication from patients and relatives were the preventing issues. Moderate harm cases were often linked with lack of communication within the unit, digital communication and not following guidelines. The interventions should be prioritised to (a) enhancing communication about work-processes, (b) verbal communication about digital prescriptions between professionals, (c) feedback among professionals and (f) encouraging patients to communicate about medication. Upon identifying the most harmful and frequent communication issues, interventions to strengthen medication safety can be implemented.
Highlights
Medication incidents are among the major issues jeopardising patient safety (Härkänen, Vehviläinen-Julkunen, Murrells, Rafferty, & Franklin, 2018;Keers et al, 2018;Manias, Cranswick, et al, 2019;WHO, 2017), accruing the equivalent of 42 billion USD in global costs annually, based on estimations of World Health Organization (WHO, 2017)
Medication incident reports from Finland (n = 500) for the year 2015 in which communication was marked as a contributing factor were used as the data source
Indicator phrases were used for searching communication issues from free texts of incident reports
Summary
Medication incidents are among the major issues jeopardising patient safety (Härkänen, Vehviläinen-Julkunen, Murrells, Rafferty, & Franklin, 2018;Keers et al, 2018;Manias, Cranswick, et al, 2019;WHO, 2017), accruing the equivalent of 42 billion USD in global costs annually, based on estimations of World Health Organization (WHO, 2017). Errors in medication communication being linked with medication incidents have been studied from specific viewpoints, such as within diverse care-provider settings or between them (Petersen, Foged, Madsen, Andersen, & Nørholm, 2018), in speciality practices (Keers et al, 2018;Liu, Manias, & Gerdtz, 2014;Manias, Cranswick, et al, 2019;Tobiano, Chaboyer, Teasdale, Raleigh, & Manias, 2019) or among specific patient age group settings (Borrott et al, 2017). Medication communication has been assessed ethnographically from the interplay viewpoint between nurses, patients, physicians and students (Liu, Gerdtz, & Manias, 2015, 2016;Rutledge, Retrosi, & Ostrowski, 2018;Schoenthaler, Allegrante, Chaplin, & Ogedegbe, 2012;Tobiano et al, 2019), and concerning professionals’ tendency to follow communicated guidelines It is challenging to prioritise communication interventions due to the lack of evaluations
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