Medication safety in collaborative health care settings: an investigation of the impact of information exchange processes in residential aged care facilities

摘要

Medication safety is a pressing concern for residential aged care facilities (RACFs). Although failures in information exchange (IE) between multiple providers have been identified as a primary cause of medication errors, there is limited evidence about the way IE impacts on medication safety. This thesis aimed to explicate the IE processes across different stages of RACF medication management and identify the gaps in these processes which increase the risk of medication errors. To achieve these aims, a naturalistic inquiry approach was employed. The research was conducted over two phases within the context of Australian RACF settings. A pilot study was conducted in one RACF to scope and describe the complex IE processes. This was followed by a multi-site study involving three RACFs to investigate gaps in IE processes across key stages of medication management and the associated risks for medication errors. Data were collected over a period of seven months. Methods included direct observations (89 hours), semi-structured interviews (n=23) and artefact analysis. Process mapping and thematic coding were used to analyse the triangulated data. Medication management in RACFs is organised around a series of information-intensive tasks. These tasks are undertaken by the physically distributed team (RACF staff, general practitioners [GPs] and community pharmacists) relying on heterogeneous communication mediums and artefacts. Several gaps were identified in IE processes which often act together to hinder medication management. They include limited information access, double handling, limited communication bandwidth, manual auditing and inadequate information handover. Findings identify that different stages of medication management are executed in isolated organisational islands and do not interact in optimal ways. The absence of coordination mechanisms and a clear division of responsibilities increase medication safety risk. To address these gaps, multifaceted technological (e.g. electronic medication charts) and human (e.g. monitoring by pharmacists) interventions are required. This research presents one of the few studies applying a holistic approach to open the ‘black box’ of IE processes and identify their impact on medication safety in collaborative health care settings. The findings highlight the need to shift the current emphasis on counting medication errors to an examination of underlying processes in order to identify factors which contribute to safe and effective medication management in these environments.