Abstract
BackgroundTransition between care settings is a time of high risk for preventable medication errors. Poor communication about medication changes on discharge from hospital can result in adverse drug events and medicines-related readmissions. Refer-to-Pharmacy is a novel electronic referral system that allows hospital pharmacy staff to refer patients from their bedside to their community pharmacist for post-hospital discharge medication support. The aim of this study was to examine factors that promoted or inhibited the implementation of Refer-to-Pharmacy in hospital and community settings.MethodsTwenty six interviews with hospital pharmacists (n = 11), hospital technicians (n = 10), and community pharmacists (n = 5) using Normalisation Process Theory (NPT) as the underpinning conceptual framework for data collection and analysis.ResultsUsing NPT to understand the implementation of the technology revealed that the participants unanimously agreed that the scheme was potentially beneficial for patients and was more efficient than previous systems (coherence). Leadership and initiation of the scheme was more achievable in the contained hospital environment, while initiation was slower to progress in the community pharmacy settings (cognitive participation). Hospital pharmacists and technicians worked flexibly together to deliver the scheme, and community pharmacists reported better communication with General Practitioners (GPs) about changes to patients’ medication (collective action). However, participants reported being unaware of how the scheme impacted patients, meaning they were unable to evaluate the effectiveness of scheme (reflexive monitoring).ConclusionThe Refer-to-Pharmacy scheme was perceived by participants as having important benefits for patients, reduced the possibility for human error, and was more efficient than previous ways of working. However, initiation of the scheme was more achievable in the single site of the hospital in comparison to disparate community pharmacy organisations. Community and hospital pharmacists and organisational leaders will need to work individually and collectively if Refer-to-Pharmacy is to become more widely embedded across health settings.
Highlights
Transition between care settings is a time of high risk for preventable medication errors
What follows is an interpretation of the findings using the four constructs of Normalisation Process Theory (NPT): Coherence In terms of making sense of the new scheme, the combination of the shared understanding of the Refer-to-Pharmacy scheme, with the potential benefits for the patients, and the distinct improvement on previous ways of working meant that coherence was strong in the hospital setting
I think in a lot of respects it’s going to save time being wasted and spent chasing things up when we are trying to get the right medication out to the people and to our patients...I think it’s going to save time, it’s not going to waste time. (Community Pharmacist 3)
Summary
Transition between care settings is a time of high risk for preventable medication errors. The transition from one care setting to another is known to be a time of high risk for preventable medication errors [1,2,3]. A lack of formal communication channels between hospitals and community settings [8] exemplifies the problems of knowledge sharing across organisational and occupational boundaries within complex health care systems [4]. This lack of knowledge sharing has the potential to contribute to post-discharge medication errors and confusion regarding appropriate discharge medication [9]
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