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ACTIONS FOR POLICY AND IMPLEMENTATION
Health professionals of different disciplines need to communicate with each other in making decisions as patients move between settings. Interdisciplinary communication will help to identify medication changes and to relay important medication information between settings.
Health professionals need reliable, efficient electronic systems to enable medication information to be transferred from hospital to general practitioners and community pharmacists, to bring about improved medication outcomes and reduced burden of care.
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AUTHORS
Prof Elizabeth Manias, Dr Kathryn Joseph and PhD candidate Guncag Ozavci (Deakin University), Prof Tracey Bucknall (Deakin University / Alfred Health), Prof Robyn Woodward-Kron (University of Melbourne), Prof Carmel Hughes, Queen’s University Belfast, Adj Prof Christine Jorm (University of Sydney).
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RESEARCH CONTEXT
This research comprised interviews, observations, and focus groups with doctors, nurses, and pharmacists to work out how they communicated with each other about managing older patients’ medications as these patients moved between different settings. The study was undertaken at an acute care hospital and at a geriatric rehabilitation hospital in Melbourne, Australia. In all, 94 health professionals took part, and 203 hours of observations were carried out.
Across settings where patients were transferred from, and receiving settings where patients were transferred to, there were challenges to bringing about effective collaboration between health professionals. Health professionals tracked back-and-forth as they communicated before patient transfers in an attempt to check medication changes, such as unusual doses. Discharge medication lists and photocopied hospital medication charts were often sent using fax, paper documents, and also accompanied patients. Extensive interruptions occurred when health professionals at the transferring settings followed up with phone calls to confirm that information was received.
Missed opportunities existed for promoting medication safety in interactions between health professionals. This is because health professionals of different disciplines rarely communicated with each other as older patients moved between settings. Instead, it was more common to see health professionals communicating with their own colleagues in the same discipline. For instance, doctors commonly communicated with each other without including pharmacists or nurses in making decisions about medication changes. This lack of inclusion led to delayed updates about medication changes after patient transfers took place. While health professionals were frustrated about these situations, they accepted these delays and reorganised their activities to attend to patients’ medication needs.
There were problems with communicating essential information between health professionals in hospitals and general practitioners in the community. Health professionals stated they were unaware how general practitioners obtained medication information from hospital. Nevertheless, these health professionals did not attempt to communicate with general practitioners to confirm whether this information had arrived or if general practitioners had any medication queries. Greater attention is needed about developing strategies for prompt relay of information to general practitioners.
Important recommendations arise from the study. Health professionals should be better prepared in communicating with each other to reduce opportunities for medication errors between settings. Clear strategies are required for how medication information is transferred to general practitioners. Enhanced interactions are needed between different health professional disciplines across various settings, particularly in relation to decisions about plans to change medications.
Interprofessional and intraprofessional medication communication between the transferring setting, receiving setting and real time communication.
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