Healthcare professionals’ perceptions on medication communication challenges and solutions – text mining and manual content analysis - cross-sectional study

Abstract

Background Communication challenges contribute to medication incidents in hospitals, but it is unclear how communication can be improved. The aims of this study were threefold: firstly, to describe the most common communication challenges related to medication incidents as perceived by healthcare professionals across specialized hospitals for adult patients; secondly, to consider suggestions from healthcare professionals with regard to improving medication communication; and thirdly, to explore how text mining compares to manual analysis when analyzing the free-text content of survey data. Methods This was a cross-sectional, descriptive study. A digital survey was sent to professionals in two university hospital districts in Finland from November 1, 2019, to January 31, 2020. In total, 223 professionals answered the open-ended questions; respondents were primarily registered nurses (77.7 %), physicians (8.6 %), and pharmacists (7.3 %). Text mining and manual inductive content analysis were employed for qualitative data analysis. Results The communication challenges were: (1) inconsistent documentation of prescribed and administered medication; (2) failure to document orally given prescriptions; (3) nurses’ unawareness of prescriptions (given outside of ward rounds) due to a lack of oral communication from the prescribers; (4) breaks in communication during care transitions to non-communicable software; (5) incomplete home medication reconciliation at admission and discharge; (6) medication lists not being updated during the inpatient period due to a lack of clarity regarding the responsible professional; and (7) work/environmental factors during medication dispensation and the receipt of verbal prescriptions. Suggestions for communication enhancements included: (1) structured digital prescriptions; (2) guidelines and training on how to use documentation systems; (3) timely documentation of verbal prescriptions and digital documentation of administered medication; (4) communicable software within and between organizations; (5) standardized responsibilities for updating inpatients’ medication lists; (6) nomination of a responsible person for home medication reconciliation at admission and discharge; and (7) distraction-free work environment for medication communication. Text mining and manual analysis extracted similar primary results. Conclusions Non-communicable software, non-standardized medication communication processes, lack of training on standardized documentation, and unclear responsibilities compromise medication safety in hospitals. Clarification is needed regarding interdisciplinary medication communication processes, techniques, and responsibilities. Text mining shows promise for free-text analysis.

Barriers and Facilitators of Communication in the Medication Reconciliation Process during Hospital Discharge: Primary Healthcare Professionals’ Perspectives

“…To the best of our knowledge, this is the first study carried out in Spain that identifies the barriers and facilitators of communication for medication reconciliation from the perspective of primary healthcare professionals. The results obtained show, along the lines of other studies, that the challenges in communication can be interlevel, involving transitions between different levels of care [23,29]; among healthcare professionals involved in primary healthcare [22,37,38]; and between healthcare professionals and patients/caregivers [39,40].…”

“…Several authors have pointed out the need to redesign interprofessional work systems to improve patient follow-up [17] In this sense, and taking into account the statements of the participants in our study, this redesign could involve improving computerized clinical histories, and the protocolization of clinical sessions or meetings that can now be carried out via videoconferences and other telematic media with some ease; this has already been proven to be useful [17,22,29]. There is no doubt that, for this to happen, it is also necessary to adjust workloads and include this communication as another care task to be carried out by healthcare professionals.…”

“…However, they do perceive the existence of technologies, such as computerized medical records, as a facilitator, although it seems that even after two decades of its implementation, they are still seen as insufficient mediums for exchanging information. This feeling is enhanced by the fact that the current tool (Diraya) appears to have not improved this communication exchange, given its structure and the display of varied and inexact information based on the healthcare professional's profile, which obliges them to look for new and more precise information [13,29,41,42]. This becomes difficult because the healthcare professionals are already overburdened with work and have little or no time available.…”

“…Therefore, initiatives that aim to improve quality and guarantee the safety of transitional care must address system fragmentation, ensure adequate professional training, and reduce communication barriers within and between healthcare settings [16,17,21,23,29]. Thus, identifying the factors that influence communication from the perspective of the healthcare professionals involved, and between professionals and patients/informal caregivers, so that medication reconciliation is carried out with all the possible safety guarantees, is of paramount importance.…”

Interpretative phenomenological analysis of the collaboration among healthcare professionals in the nursing home setting

“…These studies have frequently uncovered communication and coordination issues among healthcare professionals. 9 They further suggested that communication gaps between healthcare professionals could lead to medication errors 10 and discrepancies in treatment approaches due to insufficient interprofessional collaboration. 11 …”