Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), Yliopistonranta 1c, P.O. Box 1627, 70211, Kuopio, Finland.
University of Helsinki, Helsinki University Hospital (HUS), Meilahti Tower Hospital, building 1, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, HUS, Finland.
BMC Health Serv Res. 2021 Nov 13;21(1):1226. doi: 10.1186/s12913-021-07227-0.
Communication challenges contribute to medication incidents in hospitals, but it is unclear how communication can be improved. The aims of this study were threefold: firstly, to describe the most common communication challenges related to medication incidents as perceived by healthcare professionals across specialized hospitals for adult patients; secondly, to consider suggestions from healthcare professionals with regard to improving medication communication; and thirdly, to explore how text mining compares to manual analysis when analyzing the free-text content of survey data.
This was a cross-sectional, descriptive study. A digital survey was sent to professionals in two university hospital districts in Finland from November 1, 2019, to January 31, 2020. In total, 223 professionals answered the open-ended questions; respondents were primarily registered nurses (77.7 %), physicians (8.6 %), and pharmacists (7.3 %). Text mining and manual inductive content analysis were employed for qualitative data analysis.
The communication challenges were: (1) inconsistent documentation of prescribed and administered medication; (2) failure to document orally given prescriptions; (3) nurses' unawareness of prescriptions (given outside of ward rounds) due to a lack of oral communication from the prescribers; (4) breaks in communication during care transitions to non-communicable software; (5) incomplete home medication reconciliation at admission and discharge; (6) medication lists not being updated during the inpatient period due to a lack of clarity regarding the responsible professional; and (7) work/environmental factors during medication dispensation and the receipt of verbal prescriptions. Suggestions for communication enhancements included: (1) structured digital prescriptions; (2) guidelines and training on how to use documentation systems; (3) timely documentation of verbal prescriptions and digital documentation of administered medication; (4) communicable software within and between organizations; (5) standardized responsibilities for updating inpatients' medication lists; (6) nomination of a responsible person for home medication reconciliation at admission and discharge; and (7) distraction-free work environment for medication communication. Text mining and manual analysis extracted similar primary results.
Non-communicable software, non-standardized medication communication processes, lack of training on standardized documentation, and unclear responsibilities compromise medication safety in hospitals. Clarification is needed regarding interdisciplinary medication communication processes, techniques, and responsibilities. Text mining shows promise for free-text analysis.
沟通挑战是导致医院用药失误的原因之一，但目前尚不清楚如何改善沟通。本研究旨在达到以下三个目的：首先，描述专业医护人员在成人患者专科医院中发现的与用药失误相关的最常见沟通挑战；其次，考虑医护人员关于改善用药沟通的建议；最后，探索文本挖掘与手动分析在分析调查数据的自由文本内容时的差异。
这是一项横断面描述性研究。2019 年 11 月 1 日至 2020 年 1 月 31 日，向芬兰的两个大学医院区的专业医护人员发送了一份数字调查。共有 223 名专业医护人员回答了开放性问题；回答者主要是注册护士（77.7%）、医生（8.6%）和药剂师（7.3%）。采用文本挖掘和手动归纳内容分析对定性数据进行分析。
沟通挑战包括：（1）医嘱和给药记录不一致；（2）未记录口头医嘱；（3）护士由于缺乏医嘱下达者的口头沟通，对（在病房查房之外）下达的医嘱不知情；（4）在护理交接期间，由于非连通性软件导致沟通中断；（5）入院和出院时的家庭用药核对不完整；（6）由于负责专业人员不明确，住院期间的用药清单未及时更新；（7）在发药和接受口头医嘱时存在工作/环境因素。改善沟通的建议包括：（1）结构化的数字医嘱；（2）关于如何使用文档系统的指南和培训；（3）及时记录口头医嘱和数字记录给药情况；（4）在机构内和机构间使用连通性软件；（5）标准化更新住院患者用药清单的职责；（6）在入院和出院时指定负责家庭用药核对的人员；（7）为用药沟通提供无干扰的工作环境。文本挖掘和手动分析提取了类似的主要结果。
非连通性软件、非标准化的用药沟通流程、缺乏标准化文档记录的培训以及职责不明确都影响了医院的用药安全。需要明确跨学科用药沟通流程、技术和职责。文本挖掘在自由文本分析方面显示出了潜力。
