Abstract
BackgroundInpatient 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.MethodsWe 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.ResultsPaper 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.ConclusionPatients 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.
Highlights
Inpatient medication errors are a significant concern
We have previously explored inpatients’ views on the introduction of such systems [19], but little is known about how electronic prescribing (EP) may change the extent to which hospital inpatients are aware of their prescribed medication and feel able to actively engage in safety related activities such as querying healthcare professionals if they feel that a medication may have been prescribed, dispensed or administered in error
The limited opportunities for carers to communicate with healthcare professionals about patients’ medicines has been reported in Australia [28] and the current study has found this to be an issue in the UK
Summary
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. In this study we aimed to identify how hospital inpatients engaged with medication safetyrelated behaviours in two UK hospital trusts, the facilitators and barriers to this engagement, and the impact of EP
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