Inpatient Medication and Patient Relationships (IMPRESS)

Project summary

Background

Errors associated with prescribing and administering medication in hospital inpatients are relatively common. Although most do not result in patient harm, they can seriously affect patients’ confidence in their healthcare. Many interventions have been proposed to address these problems, although few have shown significant benefits. An approach not widely studied is to facilitate greater involvement of patients with their inpatient medication, as it is recognised that patients may potentially be an important defence against medication related errors. However, the increasing use of electronic systems in the hospital setting means that prescribing, pharmacist review and recording of medication administration potentially become more remote from the patient; this may create an additional barrier to inpatient involvement in medication safety which has not yet been explored.

This research aims to explore how hospital inpatients engage with medication safety, and how this may differ between paper-based and electronic medication records. We will then design an intervention to improve safety in this area and explore issues related to feasibility of implementation.

Outcomes

Ethnographic observations have been conducted to investigate how hospital inpatients participate in medication safety, for example by checking their own inpatient medication records, handing over information to healthcare professionals between shifts, or prompting administration of a drug to avoid dose omissions. We recorded interactions between patients with doctors, nurses and pharmacists. To explore how the use of paper-based versus electronic medication records affects such behaviours, observations were conducted on wards with established electronic prescribing and those using paper-based medication records.  Three lay volunteers also collected data in parallel with our researchers in order to provide a complementary lay perspective.

We have also conducted qualitative interviews to identify the medication safety behaviours that healthcare professionals, patients and carers believe are appropriate for patients and carers to adopt, would like to adopt, and any likely challenges and facilitators.  We have discussed the findings of the observations and interviews with a patient panel to identify interventions to help patients participate more actively with safety of their inpatient medication and are now in the process of holding stakeholder groups with a range of healthcare professionals and incorporating their input into our suggestions for interventions.

We will next repeat the observations and interviews on a ward which has recently moved from paper-based to electronic prescribing.

This work is supported by the Health Foundation, an independent charity working to continuously improve the quality of healthcare in the UK.