Abstract
BackgroundThe risks of poor information transfer across healthcare settings are well documented, particularly for medication. Various patient-held tools have been designed to hold information about patients’ medicines to improve information transfer. Anecdotal evidence suggests some are more widely implemented than others, but there has been little research exploring the reasons why. Our objectives were to explore the facilitators and barriers to implementation of patient handheld medication information from the perspective of pharmacy staff, to understand why some tools are more widely implemented than others and to make recommendations as appropriate.MethodSemi-structured interviews were conducted with 15 pharmacists and pharmacy technicians working in wards and/or dispensary of a London hospital organisation. Participants were recruited using convenience sampling. We asked about six purposefully selected tools designed to be carried by patients to provide information about their medicines, including both national and local tools, and those that were new and established. Interviews were audio-recorded and transcribed verbatim. We used framework analysis, based on a theory of behavioural change.ResultsThe majority of participants expressed the view that older tools, such as the steroid card and warfarin booklet, were used more often than newer tools such as a medication passport and a specific insulin passport. Interview data suggested that pharmacy staff did not have enough information and training about the proper use of the newer tools and therefore lacked confidence in providing them to their patients. In addition, they perceived that they were not integrated into policies and procedures with a lack of guidance regarding their use.ConclusionWe identified the main barriers to effective implementation of tools to increase patient safety across healthcare settings to be lack of guidance and training for newer tools. Making a tool available is not sufficient to ensure its use. Recommendations include clarifying guidance within the hospital organisation to standardise use of all tools and raising awareness and providing training to both healthcare professionals and patients about their use.
Highlights
The risks of poor information transfer across healthcare settings are well documented, for medication
The majority of participants expressed the view that older tools, such as the steroid card and warfarin booklet, were used more often than newer tools such as a medication passport and a specific insulin passport
Interview data suggested that pharmacy staff did not have enough information and training about the proper use of the newer tools and lacked confidence in providing them to their patients
Summary
The risks of poor information transfer across healthcare settings are well documented, for medication. The risks of poor information transfer across health care settings are well documented, for medications [1]. It has been estimated that up to 60% of patients admitted to hospitals have at least one discrepancy on their admission drug history [2]. Empirical studies suggest that in the hospital setting, prescribing errors are most likely to occur at the time of admission, largely due to challenges of medication reconciliation [4, 5]. Earlier estimates suggested that 30 to 70% of patients have either an error or an unintentional change to their medicines when admitted to hospital [3]. A survey completed by 1133 London general practitioners to identify priorities for improvement of medication safety in primary care identified incomplete reconciliation of medication as the highest priority [9]
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