Using a structured, patient-centred, educational exchange to facilitate a shared conversation about stroke prevention medications.

OBJECTIVE: The aim of this study was to investigate the feasibility of a structured patient-centred educational exchange to facilitate a shared conversation about stroke prevention medications. METHODS: Participants (18 years or older) with a principal diagnosis of stroke or transient ischaemic attack were purposively sampled from the stroke unit of a 780-bed teaching hospital in Australia and consented to participate in the study. A patient-centred educational exchange was conducted face to face at the bedside before discharge and by telephone post discharge. The structure of these sessions was adapted from academic detailing, an educational strategy, which includes identifying experience, listening to the needs of the audience, and tailoring messages to influence behaviour. To facilitate sharing of needs, three questionnaires, validated as research tools, were used to identify participants' experience, perceptions, and beliefs. The identified perceptions were used to personalize educational messages. The outcomes of the study were to provide descriptions of patients' perceptions necessities and concerns about their condition and medications, provide examples of personalized responses to these, evaluate acceptability by patients, and determine the time taken to share the information. RESULTS: Sixteen participants completed both the bedside session (average duration 27 minutes) and the telephone follow-up (average duration 23 minutes). The strongest patient concern identified was having another stroke. Personalized responses included emphasizing long-term treatment in response to the perception that stroke will last for a short time, reinforcement of necessity for medications, and further exploration of concerns. CONCLUSION: The questionnaires engaged the participants, allowing them to share perceptions and beliefs, facilitating a patient-centred educational exchange in a timely manner.

Why do interns make prescribing errors? A qualitative study.

OBJECTIVE: To identify and analyse factors underlying intern prescribing errors to inform development of specific medication-safety interventions. DESIGN: A prospective qualitative study that involved face-to-face interviews and human-factor analysis. SETTING: A tertiary referral teaching hospital, Brisbane, Queensland, February-June, 2004. PARTICIPANTS: Fourteen intern prescribers involved in 21 errors. METHOD: A structured questionnaire was used to identify factors causing the errors. Transcripts were analysed on the basis of human-error theory to identify underlying themes. MAIN OUTCOME MEASURES: Factors underlying prescribing errors. RESULTS: Errors were multifactorial, with a median of 4 (range, 2-5) different types of performance-influencing factors per error. Lack of drug knowledge was not the single causative factor in any incident. The factors in new-prescribing errors included team, individual, patient and task factors. Factors associated with errors in represcribing were environment, task and number of weeks into the term. Defences against error, such as other clinicians and guidelines, were porous, and supervision was inadequate or not tailored to the patient, task, intern or environment. Factors were underpinned by an underlying culture in which prescribing is seen as a repetitive low-risk chore. CONCLUSION: To reduce the risk of prescribing errors, a range of strategies addressing patient, task, individual, team and environment factors must be introduced.