Safe medication management in hospital settings
Despite an increased focus on patient safety and healthcare quality, errors and adverse outcomes remain prevalent in hospitals. Education about the roles and responsibilities of medication management is required for health professionals, patients and families to increase inclusion and engagement across the health continuum and support transition to discharge.
There is emerging evidence that patients can promote their own safety when they participate in safety activities during their hospitalisation. However, little is known about opportunities for workflow redesign to promote patient participation and accommodate patient preferences for their participation.
Understanding when and how patients can be involved in safety activities is necessary to design effective interventions to improve patient engagement and, potentially, patient outcomes. The overall aim of this project was to investigate the policies influencing medication administration practices, nurses’ workflow and patients’ preferences for information and involvement in medication management in various hospital settings.
The research consisted of three studies. Study one determined the variability in medication administration policies across QPS partnership organisations by completing a policy analysis.
Study two examined nurses’ workflow during medication management using observations and interviews, and study three identified patient preferences for information about and involvement in medication management throughout their hospitalisation by conducting semi-structured interviews with patients.
The research team discovered that medication management policies across seven Victorian health services varied in relation to medications that require single- and double-checking as well as by whom, nurse-initiated medications, administration rights, telephone orders and competencies required to check medications. The team also demonstrated that nurses work in complex adaptive systems that change moment by moment.
Acknowledging and understanding the cognitive workload and these complex interactions is necessary to improve patient safety and reduce errors during medication administration. Knowing and involving the patient is also an important part of a nurse’s medication administration safety strategy.
The research also revealed significant diversity in patients’ opinions about their own involvement in medication management in hospital, and, where appropriate, their preferences should be identified on admission.
This project was funded by QPS and led by Alfred Deakin Professor Tracey Bucknall, Professor Elizabeth Manias, Alfred Deakin Professor Alison Hutchinson, Adjunct Professor Janet Weir-Phyland, Professor Julie Considine, Alfred Deakin Professor Mari Botti, Professor Trisha Dunning and Dr Robin Digby with partners Alfred Health, Barwon Health, Eastern Health, Epworth HealthCare, Monash Health, QPS and Deakin.