Understanding medication safety involving patient transfer from intensive care to hospital ward: a qualitative sociotechnical factor study

Abstract

ObjectiveTo understand the sociotechnical factors affecting medication safety when intensive care patients are transferred to a hospital ward. Consideration of these medication safety factors would provide a theoretical basis, on which future interventions can be developed and evaluated to improve patient care.DesignQualitative study using semistructured interviews of intensive care and hospital ward-based healthcare professionals. Transcripts were anonymised prior to thematic analysis using the London Protocol and Systems Engineering in Patient Safety V.3.0 model frameworks.SettingFour north of England National Health Service hospitals. All hospitals used electronic prescribing in intensive care and hospital ward settings.ParticipantsIntensive care and hospital ward healthcare professionals (intensive care medical staff, advanced practitioners, pharmacists and outreach team members; ward-based medical staff and clinical pharmacists).ResultsTwenty-two healthcare professionals were interviewed. We identified 13 factors within five broad themes, describing the interactions that most strongly influenced the performance of the intensive care to hospital ward system interface. The themes were: Complexity of process performance and interactions; Time pressures and considerations; Communication processes and challenges; Technology and systems and Beliefs about consequences for the patient and organisation.ConclusionsThe complexity of the interactions on the system performance and time dependency was clear. We make several recommendations for policy change and further research based on improving: availability of hospital-wide integrated and functional electronic prescribing systems, patient flow systems, sufficient multiprofessional critical care staffing, knowledge and skills of staff, team performance, communication and collaboration and patient and family engagement.

What factors in the workplace enable success in antimicrobial stewardship in paediatric intensive care? An exploration of antimicrobial stewardship excellence through thematic analysis of appreciative inquiry interviews with healthcare staff

“…A recent qualitative study from adult ICU settings identified 13 sociotechnical factors impacting medication safety in patients transitioning from ICU to ward environments. 14 These factors, grouped into five themes, align with our study’s findings, including the importance of diverse professional expertise, written communication, tool and technology availability, beliefs about consequences of medication errors and physical environment factors. However, the study also discovered additional factors not found in our research, such as the positive effect of patient and family involvement post-ICU discharge, and the role of prescription annotations.…”

Qualitative Insights Into Patients' and Family Members’ Experiences of In-Hospital Medication Management After a Critical Care Episode

“…Patients and family members concurred with HCPs that when acutely ill, patients often were unable to have an active role in decisions about their medications. 18 During this period, the patient advocacy role of family members was vital. Manias et al 30 also identified the important role family members have in medication safety in an observational study of communication between intensive care HCPs and patients and family members.…”

“… 16 , 17 In contrast, HCPs perceive barriers to routine engagement and information provision for patients and families after a critical care episode. 14 , 18 HCPs’ and public representatives’ beliefs can differ on the importance of medication information provision to improve medication safety, 15 contributing to patient reports of inadequate communication, predisposing them to anxiety or distress on transition of care. 19 …”