Braaf Sandra, Rixon Sascha, Williams Allison, Liew Danny, Manias Elizabeth
Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Vic., Australia.
Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Vic., Australia.
J Clin Nurs. 2015 Oct;24(19-20):2859-70. doi: 10.1111/jocn.12894. Epub 2015 Jul 16.
To investigate what and how medication information is communicated during handover interactions in specialty hospital settings.
Effective communication about patients' medications between health professionals and nurses at handover is vital for the delivery of safe continuity of care.
An exploratory qualitative design and observational study.
Participant observation was undertaken at a metropolitan Australian public hospital in four specialty settings: cardiothoracic care, intensive care, emergency care and oncology care. A medication communication model was applied to the data and thematic analysis was performed.
Over 130 hours of observational data were collected. In total, 185 (predominately nursing) handovers were observed across the four specialty settings involving 37 nurse participants. Health professionals communicated partial details of patients' medication regimens, by focusing on auditing the medication administration record, and through the handover approach employed. Gaps in medication information at handover were evident as shown by lack of communication about detailed and specific medication content. Incoming nurses rarely posed questions about medications at handover.
Handover interactions contained restricted and incomplete medication information. Improving the transparency, completeness and accuracy of medication communication is vital for optimising patient safety and quality of care in specialty practice settings.
For nurses to make informed and rapid decisions regarding appropriate patient care, information about all types of prescribed medications is essential, which is communicated in an explicit and clear way. Jargon and assumptions related to medication details should be minimised to reduce the risk of misunderstandings. Disclosure of structured medication information supports nurses to perform accurate patient assessments, make knowledgeable decisions about the appropriateness of medications and their doses, and anticipate possible adverse events associated with medications. In addition, benefits of patient and family member contributions in communicating about medications at handover should also be considered.
调查在专科医院环境中，交接班互动期间药物信息是如何传递的以及传递了哪些信息。
医护人员与护士在交接班时就患者用药情况进行有效沟通，对于提供安全的连续性护理至关重要。
探索性定性设计与观察性研究。
在澳大利亚一家大都市公立医院的四个专科科室进行参与观察，这四个科室分别是心胸护理科、重症监护室、急诊科和肿瘤科。将药物沟通模型应用于数据，并进行主题分析。
收集了超过130小时的观察数据。在这四个专科科室共观察到185次（主要是护理方面的）交接班，涉及37名护士参与者。医护人员通过专注于审核用药记录以及采用的交接班方式，传达了患者用药方案的部分细节。由于缺乏关于详细和具体药物内容的沟通，交接班时药物信息存在明显缺口。接班护士在交接班时很少就药物问题提问。
交接班互动中包含的药物信息有限且不完整。提高药物沟通的透明度、完整性和准确性对于优化专科医疗环境中的患者安全和护理质量至关重要。
护士要对适当的患者护理做出明智且迅速的决策，所有类型的处方药物信息至关重要，这些信息应以明确清晰的方式传达。与药物细节相关的行话和假设应减至最少，以降低误解风险。披露结构化的药物信息有助于护士进行准确的患者评估，就药物及其剂量的适宜性做出明智决策，并预测与药物相关的可能不良事件。此外，还应考虑患者及其家属在交接班时参与药物沟通的益处。
