Communicating with patients, families and health professionals about managing medications in intensive care: A qualitative observational study.

OBJECTIVES: To explore communication between patients, families, and health professionals about managing medications in intensive care. DESIGN: A qualitative exploratory study was undertaken using participant observations. A thematic analysis of the data was performed. SETTING: The setting comprised an intensive care unit at a public, teaching hospital in Melbourne, Australia. FINDINGS: Three themes were identified: provision of information, therapeutic relationships, and patient and family centred care. Nurses and pharmacists communicated regularly about medications with patients and family members. Doctors were occasionally present at the bedside during medical ward rounds or in undertaking medical procedures and subsequently their patient and family interactions about managing medications tended to be minimal. Pharmacists spent time in clarifying patients' medication history prior to their admission to the intensive care unit. Nurses were at the forefront of communication with patients and their family members. However, nurses sometimes missed cues and valuable opportunities to respond to families' concerns during their interactions. Communication was commonly hampered by time constraints and competing responsibilities of health professionals. CONCLUSION: Communication tended to involve clarification of patients' medication history and the ways in which medications affected patients' clinical status or medical condition. Attention is needed in attending to cues from families in communicating about medications.

The functions and roles of questioning during nursing handovers in specialty settings: an ethnographic study.

BACKGROUND: Nursing handovers are an important component of patient safety and quality in communicating across transitions of care. OBJECTIVES: To determine the functions and roles of questions in nursing handovers, and of how questions contribute to handover quality improvement in specialty settings of an Australian tertiary hospital. DESIGN: An ethnographic research design was employed. METHODS: Participant observations were conducted which were audiorecorded and transcribed. Question-response sequences and the roles of questions in the handovers were coded. RESULTS: Questions served many functions, and included: requests for information, requests for confirmation, other initiations of repair, outloud utterances, understanding checks, requests for action and agreement, and knowledge checks. CONCLUSIONS: Questioning was mostly used to transmit patient-related information, and nurses could use questioning to jointly construct understandings about patients. Future research should examine how questions function in diverse clinical environments, such as rural and regional hospitals, and how questioning occurs in multidisciplinary handover situations.

Effectiveness of educational communication interventions for health professionals to improve quality of care in emergency departments: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to evaluate the effectiveness of educational communication interventions for health professionals in emergency departments. The end result is to identify the specific types of communication based educational strategies utilized by emergency department health care professionals to enhance the quality of care for patients.

Communication and Influencing for ED Professionals: A training programme developed in the emergency department for the emergency department.

OBJECTIVE: The objective of the present study is to develop and pilot a communication and influencing skills training programme that meets ED health professionals' needs at an urban district hospital. METHODS: Qualitative methods within a participatory action research framework were utilised. An interdisciplinary team guided the programme's design and development. A training needs analysis saw team meetings, interviews, focus groups and observations conducted across the ED. Thematic analysis of the data identified health professionals' communication and influencing challenges. The training needs analysis informed the training programme curriculum's development. The pilot programme involved an interdisciplinary group of seven health professionals across 5 × 2 h sessions over 3 months, followed by a post-training survey. RESULTS: Five themes of communication and influencing challenges were identified: participating in effective handovers, involving patients in bedside handovers, effectively communicating with interdepartmental colleagues, asking ED colleagues to do tasks and understanding ED colleagues' roles, expectations and assumptions. Based on these challenges, the formulated RESPECT model (which stands for Relationships, Expectations, Styles, Partnerships, Enquiry, Coaching and Teamwork) informed the training curriculum. The peer coaching model used in the training programme was highly regarded by participants. CONCLUSIONS: Communication and Influencing for ED Professionals™ (Babel Fish Group Pty Ltd, Melbourne, Victoria, Australia) addresses a gap for communication programmes developed in the ED for the ED. Future research will evaluate the programme's impact in this ED.

Medication communication during handover interactions in specialty practice settings.

AIMS AND OBJECTIVES: To investigate what and how medication information is communicated during handover interactions in specialty hospital settings. BACKGROUND: Effective communication about patients' medications between health professionals and nurses at handover is vital for the delivery of safe continuity of care. DESIGN: An exploratory qualitative design and observational study. METHODS: Participant observation was undertaken at a metropolitan Australian public hospital in four specialty settings: cardiothoracic care, intensive care, emergency care and oncology care. A medication communication model was applied to the data and thematic analysis was performed. RESULTS: Over 130 hours of observational data were collected. In total, 185 (predominately nursing) handovers were observed across the four specialty settings involving 37 nurse participants. Health professionals communicated partial details of patients' medication regimens, by focusing on auditing the medication administration record, and through the handover approach employed. Gaps in medication information at handover were evident as shown by lack of communication about detailed and specific medication content. Incoming nurses rarely posed questions about medications at handover. CONCLUSIONS: Handover interactions contained restricted and incomplete medication information. Improving the transparency, completeness and accuracy of medication communication is vital for optimising patient safety and quality of care in specialty practice settings. RELEVANCE TO CLINICAL PRACTICE: For nurses to make informed and rapid decisions regarding appropriate patient care, information about all types of prescribed medications is essential, which is communicated in an explicit and clear way. Jargon and assumptions related to medication details should be minimised to reduce the risk of misunderstandings. Disclosure of structured medication information supports nurses to perform accurate patient assessments, make knowledgeable decisions about the appropriateness of medications and their doses, and anticipate possible adverse events associated with medications. In addition, benefits of patient and family member contributions in communicating about medications at handover should also be considered.

Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings.

BACKGROUND: Communication problems contribute enormously to medication errors and adverse events. Encouraging patient engagement can help to facilitate effective medication management. OBJECTIVES: To examine barriers and enablers affecting how patients engage with managing their medications in specialty hospital settings. DESIGN: An exploratory qualitative design was used involving in-depth interviews with doctors, nurses, pharmacists, patients and family members. SETTING: An Australian public, metropolitan teaching hospital was the study site and five specialty hospital settings were used, including cardiac care, emergency care, intensive care, oncology care and perioperative care. RESULTS: In all, 21 health professionals, 11 patients and 12 family members participated in the study (n = 44). Barriers and enablers involved intrapersonal, interpersonal and environmental aspects, and differences in perceptions and experiences were found between the various settings. Health professionals had preconceived notions of what was appropriate behaviour in conveying information about medications. Many health professionals stated that they deliberately chose not to provide medication-related knowledge. Different barriers for patient engagement existed in various settings - in emergency care, patients could only stay for 4 h; in intensive care, medication changes regularly happened; in cardiac care, patients were discharged prematurely due to urgent need of beds; in oncology, there was lack of availability of oncology consultants; while in perioperative care, surgeons and anaesthetists were available just before surgery. CONCLUSIONS: Complex barriers and enablers are associated with patient engagement in specialty clinical settings. By developing an understanding of these barriers and enablers, health professionals can help patients to understand and participate in their medication management.

Pharmacists' Interprofessional Communication About Medications in Specialty Hospital Settings.

Effective communication between pharmacists, doctors, and nurses about patients' medications is particularly important in specialty hospital settings where high-risk medications are frequently used. This article describes the nature of communication about medications that occurs between pharmacists and other health professionals, including doctors and nurses, in specialty hospital settings. Semistructured interviews with, and participant observations of, pharmacists, nurses, and doctors were conducted in specialty settings of an Australian public, metropolitan teaching hospital. Twenty-one individuals working in the settings of emergency care, oncology care, intensive care, cardiothoracic care, and perioperative care were interviewed. In addition, participant observations of 56 individuals were conducted in emergency care, oncology care, intensive care, and cardiothoracic care. Detailed thematic analysis of the data was performed. Across all of the settings, pharmacy was less visible than medicine and nursing in terms of pharmacists' work performed, pharmacy documentation and resources, and pharmacists' physical visibility. Pharmacists, doctors, and nurses largely worked alongside one another rather than with each other. When collaboration occurred, the professional groups engaged in mostly reactive communication to accomplish specific medication tasks that needed completing. Interprofessional differences in attitudes toward medications and medication management communication behaviors were evident. Pharmacists need to engage in more proactive communication in order to reduce the risk of medication errors occurring.

Effects of patient-, environment- and medication-related factors on high-alert medication incidents.

OBJECTIVE: To measure the rate of medication incidents associated with the prescription and administration of high-alert medications and to identify patient-, environment- and medication-related factors associated with these incidents. DESIGN: A retrospective chart audit design was conducted of medical records for patient admissions from 1 January 2010 to 31 December 2010. SETTING: Five practice settings (cardiac care, emergency care, intensive care, oncology care and perioperative care) at a public teaching hospital in Melbourne, Australia. PARTICIPANTS: Patients were considered for inclusion if they were prescribed at least one high-alert medication and if they were admitted to one of five practice settings. MAIN OUTCOME MEASURES: High-alert prescribing and administering incidents were measured in each of the five practice settings. Generalized linear mixed modeling was used for data analysis. RESULTS: There were 6984 opportunities for high-alert medication incidents across the five clinical settings. The overall medication incident rate was 1934/6984 (27.69%). There were 1176 prescribing incidents (16.84%) and 758 administering incidents (10.85%). Statistical modeling showed that, in each of the five clinical settings, an increased number of ward transfers was associated with increased odds of prescribing incidents. In addition, statistical modeling demonstrated that an increased number of ward transfers was associated with increased odds of administering incidents in emergency care and perioperative care. CONCLUSIONS: Complex relationships were found in managing high-alert medications in specialty clinical settings. Employing measures to address patients' movements across ward settings can reduce high-alert medication incidents and improve quality of care.