School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood 3125, Australia.
Deakin-Alfred Health Nursing Research Centre, Alfred Health, Melbourne 3004, Australia.
Int J Environ Res Public Health. 2021 Apr 8;18(8):3925. doi: 10.3390/ijerph18083925.
Communication breakdowns contribute to medication incidents involving older people across transitions of care. The purpose of this paper is to examine how interprofessional and intraprofessional communication occurs in managing older patients' medications across transitions of care in acute and geriatric rehabilitation settings. An ethnographic design was used with semi-structured interviews, observations and focus groups undertaken in an acute tertiary referral hospital and a geriatric rehabilitation facility. Communication to manage medications was influenced by the clinical context comprising the transferring setting (preparing for transfer), receiving setting (setting after transfer) and 'real-time' (simultaneous communication). Three themes reflected these clinical contexts: dissemination of medication information, safe continuation of medications and barriers to collaborative communication. In transferring settings, nurses and pharmacists anticipated communication breakdowns and initiated additional communication activities to ensure safe information transfer. In receiving settings, all health professionals contributed to facilitating safe continuation of medications. Although health professionals of different disciplines sometimes communicated with each other, communication mostly occurred between health professionals of the same discipline. Lack of communication with pharmacists occurred despite all health professionals acknowledging their important role. Greater levels of proactive preparation by health professionals prior to transfers would reduce opportunities for errors relating to continuation of medications.
沟通障碍导致老年人在医疗护理转移过程中发生用药事故。本文旨在探讨在急性和老年康复环境中，跨医疗护理转移管理老年患者药物时，如何进行跨专业和专业内的沟通。本研究采用民族志设计，在一家急性三级转诊医院和一家老年康复机构进行了半结构化访谈、观察和焦点小组。沟通以管理药物为重点，受到包括转介环境（准备转介）、接收环境（转介后环境）和“实时”（同步沟通）在内的临床环境影响。三个主题反映了这些临床环境：药物信息的传播、药物的安全使用以及协作沟通的障碍。在转介环境中，护士和药剂师预计会出现沟通障碍，并开展额外的沟通活动，以确保安全的信息传递。在接收环境中，所有卫生专业人员都有助于促进药物的安全使用。尽管不同学科的卫生专业人员有时会相互沟通，但沟通大多发生在同一学科的卫生专业人员之间。尽管所有卫生专业人员都承认药剂师的重要作用，但与药剂师的沟通却很少。在转介前，卫生专业人员更积极地准备，可以减少与药物使用相关的错误发生的机会。
