Medication communication between nurses and doctors for paediatric acute care: An ethnographic study

AIMS AND OBJECTIVES: To examine how communication between nurses and doctors occurred for managing medications in inpatient paediatric settings. BACKGROUND: Communication between health professionals influences medication incidents' occurrence and safe care. DESIGN: An ethnographic study was undertaken. METHODS: Semi-structured interviews, observations and focus groups were conducted in three clinical areas of an Australian tertiary paediatric hospital. Data were transcribed verbatim and thematically analysed using the Medication Communication Model. RESULTS: The actual communication act revealed professionals' commitment to effective medication management and the influence of professional identities on medication communication. Nurses and doctors were dedicated to providing safe, effective medication therapy for children, within their scope of practice and perceived role responsibilities. Most nurses and junior doctors used tentative language in their communication while senior doctors tended to use direct language. Irrespective of language style, nurses actively engaged with doctors to promote patients' needs. Yet, the medical hierarchical structure, staffing and attendant expectations influenced communication for medication management, causing frustration among nurses and doctors. Doctors' lack of verbal communication of documented changes to medication orders particularly troubled nurses. Nurses persisted in their efforts to acquire appropriate orders for safe medication administration to paediatric patients. CONCLUSIONS: Collaborative practice between nurses and doctors involved complex, symbiotic relationships. Their dedication to providing safe medication therapy to paediatric patients facilitated effective medication management. At times, shortcomings in inter-disciplinary communication impacted on potential and actual medication incidents. RELEVANCE TO CLINICAL PRACTICE: Understanding of the complexities affecting medication communication between nurses and doctors helps to ensure inter-professional respect for each other's roles and inherent demands. Interdisciplinary education delivered in health care organisations would facilitate greater clarity in communication related to medications. Encouraging the use of concise, clear words in communication would help to promote improved understanding between parties, and accuracy and efficacy of medication management. This article is protected by copyright. All rights reserved

Interdisciplinary medication decision making by pharmacists in pediatric hospital settings: An ethnographic study

OBJECTIVE: Children are particularly vulnerable to experiencing medication incidents in hospitals. Making sound medication decisions is therefore of paramount importance. Prior research has principally described pharmacists' role in reducing medication errors. There is a dearth of information about pharmacists' interactions with pediatric hospital staff across disciplines in resolving medication issues. The aim of this study was to examine interdisciplinary medication decision making by pharmacists in pediatric hospital settings. DESIGN: An ethnographic design was undertaken comprising observations, semi-structured interviews and focus groups. Audio-recorded data were analyzed thematically. SETTING: The study was conducted in three wards of an Australian pediatric tertiary teaching hospital, comprising general surgical, gastroenterology, endocrinology, neurology, adolescent and rehabilitation settings. PARTICIPANTS: Pharmacists, registered nurses and doctors were recruited from diverse clinical wards following information sessions. RESULTS: Pharmacists were central to complex pediatric medication decision making, intervening about dosage, administration, drug interactions and authorities. Pharmacists proactively contacted doctors and nurses about prescribing issues; conversely, staff routinely approached pharmacists for medication advice. Pharmacists were perceived as medication experts, their extensive knowledge valued in resolving complex issues: when off-label medications were prescribed, when protocols were absent or ambiguous, where tension existed between protocol adherence and patient safety, and where patients on multiple medications were at risk of medication error. Pharmacists had strong relationships with doctors and nurses, which had a bearing on pharmacists' input in interventions. Furthermore, pharmacists identified prescribing errors through strategies, such as case note review and medication reconciliation, although the lack of emergency department pharmacists and limited after-hours staffing posed challenges to both strategies. CONCLUSIONS: Pharmacists made a substantial and highly valued contribution to pediatric inter-professional medication decision making. These results provide new knowledge that informs theoretical developments of pharmacists' role in decision making

Perspectives of nurses' role in interprofessional pharmaceutical care across 14 European countries: A qualitative study in pharmacists, physicians and nurses.

OBJECTIVES: To understand healthcare professionals' experiences and perceptions of nurses' potential or ideal roles in pharmaceutical care (PC). DESIGN: Qualitative study conducted through semi-structured in-depth interviews. SETTING: Between December 2018 and October 2019, interviews were conducted with healthcare professionals of 14 European countries in four healthcare settings: hospitals, community care, mental health and long-term residential care. PARTICIPANTS: In each country, pharmacists, physicians and nurses in each of the four settings were interviewed. Participants were selected on the basis that they were key informants with broad knowledge and experience of PC. DATA COLLECTION AND ANALYSIS: All interviews were conducted face to face. Each country conducted an initial thematic analysis. Consensus was reached through a face-to-face discussion of all 14 national leads. RESULTS: 340 interviews were completed. Several tasks were described within four potential nursing responsibilities, that came up as the analysis themes, being: 1) monitoring therapeutic/adverse effects of medicines, 2) monitoring medicines adherence, 3) decision making on medicines, including prescribing 4) providing patient education/information. Nurses' autonomy varied across Europe, from none to limited to a few tasks and emergencies to a broad range of tasks and responsibilities. Intended level of autonomy depended on medicine types and level of education. Some changes are needed before nursing roles can be optimised and implemented in practice. Lack of time, shortage of nurses, absence of legal frameworks and limited education and knowledge are main threats to European nurses actualising their ideal role in PC. CONCLUSIONS: European nurses have an active role in PC. Respondents reported positive impacts on care quality and patient outcomes when nurses assumed PC responsibilities. Healthcare professionals expect nurses to report observations and assessments. This key patient information should be shared and addressed by the interprofessional team. The study evidences the need of a unique and consensus-based PC framework across Europe

Interventions to reduce medication errors in pediatric intensive care

To systematically examine the research literature to identify which interventions reduce medication errors in pediatric intensive care units

Nursing students' belongingness and workplace satisfaction: Quantitative findings of a mixed methods study

© 2016 Elsevier Ltd Background The relationship between nursing students' belongingness and workplace satisfaction has received limited attention in the literature to date. Aim The aim of this study was to explore the relationship between, and factors that may influence final semester nursing students' need to belong, sense of belonging and workplace satisfaction while on clinical placements. Methods A cross-national longitudinal multiphase explanatory sequential mixed methods study underpinned by a pragmatic theoretical framework was used for this study. A convenience sample of third-year nursing students from two Australian and one Canadian university (n = 468) were recruited. Participants were asked to complete a 62 item survey which was a composite of three previously validated surveys: the 10 item ‘Need to Belong Scale’, the 34 item ‘Belongingness Scale: Clinical Placement Experience (BES:CPE)’ and the 18 item ‘Nursing Workplace Satisfaction Questionnaire’. Data were analysed using descriptive and inferential statistics. Results Key results indicated that participants wanted to have someone to turn to, and to be accepted; they found nursing work interesting and considered it worthwhile to make an effort in this meaningful job. Participants were usually comfortable to ask for and accept help but many felt discriminated against during clinical placements. Only belongingness was strongly correlated with workplace satisfaction. Conclusions Irrespective of site, nursing students' satisfied sense of belonging influenced their workplace satisfaction while on clinical placements. Workplace satisfaction is a key determinant of career decisions and the results from this study have the potential to inform clinical placement practices and policies and to influence beginning nurses' decisions to continue in the profession

Medication error trends and effects of person-related, environment-related and communication-related factors on medication errors in a paediatric hospital

AIM: This study aimed to examine reported medication error trends in an Australian paediatric hospital over a 5-year period and to determine the effects of person-related, environment-related and communication-related factors on the severity of medication outcomes. In particular, the focus was on the influence of changes to a hospital site and structure on the severity of medication errors. METHODS: A retrospective clinical audit was undertaken over a 5-year period of paediatric medication errors submitted to an online voluntary reporting system of an Australian, tertiary, public teaching paediatric hospital. All medication errors submitted to the online system between 1 July 2010 and 30 June 2015 were included. RESULTS: A total of 3340 medication errors was reported, which corresponded to 0.56% medication errors per combined admissions and presentations or 5.73 medication errors per 1000 bed days. The most common patient outcomes related to errors requiring monitoring or an intervention to ensure no harm occurred (n = 1631, 48.8%). A new hospital site and structure had 0.354 reduced odds of producing medication errors causing possible or probable harm (95% confidence interval 0.298-0.421, P < 0.0001). Patient and family involvement had 1.270 increased odds of identifying medication errors associated with possible or probable harm compared with those causing no harm (95% confidence interval 1.028-1.568, P = 0.027). Interrupted time series analyses showed that moving to a new hospital site and structure was associated with a reduction in reported medication errors. CONCLUSION: Encouraging child and family involvement, facilitating hospital redesign and improving communication could help to reduce the harm associated with medication errors

The use of focus groups to develop a culturally relevant quality of life tool for lymphatic filariasis in Bangladesh

Purpose\ud The purpose of this study was to conduct focus groups to operationalise the construct of quality of life (QOL) for people living with lymphatic filariasis (LF) in Bangladesh to develop culturally valid items for a Bangladeshi LF QOL tool.\ud \ud Methods\ud Ten focus groups were conducted with a stratified purposeful sample (n = 60) of LF patients (3 focus groups, n = 17), doctors (1 focus group, n = 5), nurses (1 focus group, n = 6) and other hospital staff (1 focus group, n = 5), community leaders (2 focus groups, n = 14), community volunteer health workers (1 focus group, n = 5) and Bangladeshi LF researchers and planners (1 focus group, n = 8). Focus group methodology was informed by local culture in consultation with cultural mentors and local advisors, often going against standard focus group procedures. Data were collected through note taking, audio taping, transcripts, observational notes and a reflection diary. Open coding of transcript data was completed until data saturation was achieved.\ud \ud Results\ud Forty-three constructs were identified through the focus groups that had not previously been identified in the literature, including constructs relating to environmental supports and barriers, activities, participation and psychological impacts. There were marked differences between the impacts reported by different groups, highlighting the need for a comprehensive purposive sample. In particular, contributions from participants who would not traditionally be viewed as "experts" were vital.\ud \ud Conclusions\ud The use of focus groups strongly contributed to the operationalisation of the concept of QOL in Bangladesh for people living with LF. Use of literature review or expert opinion alone would have missed vital constructs