初级医生与医院药剂师就处方开具问题的沟通：一项定性访谈研究的结果
Junior doctors' communication with hospital pharmacists about prescribing: findings from a qualitative interview study.
作者信息
Axon David Rhys, Lim Rosemary Hwee Mei, Lewis Penny J, Sandher Sarena, Thondee Jenna, Edwards Karen, Howard Rachel L
机构信息
Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, Arizona, USA.
Reading School of Pharmacy, University of Reading, Reading, UK.
出版信息
Eur J Hosp Pharm. 2018 Sep;25(5):257-261. doi: 10.1136/ejhpharm-2017-001449. Epub 2018 Feb 6.
OBJECTIVES
To explore factors affecting communication between Foundation Year (FY) 1 doctors and hospital pharmacists about prescribing from the junior doctors' perspective.
METHODS
Trained interviewers (n=4) conducted semistructured interviews with FY1 doctors who were purposively sampled from three hospitals in England. FY1 doctors were asked about their experiences of communication with hospital pharmacists about their prescribing; instances where they disagreed with or did not implement a hospital pharmacist's recommendation; and their preferences for communicating with hospital pharmacists about prescribing. Interviews were audiorecorded, transcribed verbatim and analysed thematically.
RESULTS
A total of 27 FY1 doctors were interviewed. Findings were categorised into four main themes: (1) nature and context of communication; (2) FY1 doctors' perceptions of communication with hospital pharmacists; (3) factors influencing FY1 doctors' decision whether to act on pharmacists' prescribing recommendations; and (4) suggestions to improve communication with pharmacists. FY1 doctors and hospital pharmacists generally communicated well. FY1 doctors appreciated and frequently acted on pharmacists' advice yet there was deference to senior medical staff when advice differed. Joint ward rounds, pharmacist-led teaching sessions and a standardised approach to communication were all suggested as ways to improve communication and may increase the likelihood of pharmacists' recommendations being acted on.
CONCLUSIONS
FY1 doctors and hospital pharmacists communicated frequently about medication prescribing. Issues occurred when there were differences in professional judgement between senior medical staff and pharmacists but these were usually resolved satisfactorily for the FY1 doctor. Further interventions to improve communication and safe prescribing could involve a multidisciplinary and systems approach.
目的
从初级医生的角度探讨影响一年级住院医生（FY1）与医院药剂师之间处方沟通的因素。
方法
训练有素的访谈者（n = 4）对从英格兰三家医院中特意抽取的FY1医生进行了半结构化访谈。询问FY1医生关于他们与医院药剂师就处方进行沟通的经历；他们不同意或未执行医院药剂师建议的情况；以及他们对与医院药剂师就处方进行沟通的偏好。访谈进行了录音，逐字转录并进行了主题分析。
结果
共访谈了27名FY1医生。研究结果分为四个主要主题：（1）沟通的性质和背景；（2）FY1医生对与医院药剂师沟通的看法；（3）影响FY1医生决定是否按照药剂师的处方建议行事的因素；（4）改善与药剂师沟通的建议。FY1医生和医院药剂师总体沟通良好。FY1医生赞赏并经常按照药剂师的建议行事，但当建议不同时会尊重高级医务人员的意见。联合病房查房、药剂师主导的教学课程和标准化的沟通方式都被建议作为改善沟通的方法，并且可能会增加药剂师的建议被采纳的可能性。
结论
FY1医生和医院药剂师就药物处方进行了频繁沟通。当高级医务人员和药剂师之间的专业判断存在差异时会出现问题，但对于FY1医生来说这些问题通常都能得到令人满意的解决。进一步改善沟通和安全处方的干预措施可能需要采取多学科和系统性的方法。
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