Complexities of medicines safety: communicating about managing medicines at transition points of care across emergency departments and medical wards

Aims and objectives To explore how health professionals, patients and family members communicate about managing medicines across transition points of care in two Australian public hospitals. Background Medicines errors are common at transition points of care. Little qualitative work has targeted communicating about medicines management across patients' journeys from admission through to discharge. Design A qualitative descriptive study was undertaken. Methods In‐depth, semi‐structured interviews were conducted with patients and family members, and focus groups and interviews were undertaken with doctors, nurses and pharmacists (n = 103). These individuals were situated in emergency departments and general medical wards. Data were analysed using thematic analysis. Results Four themes were identified: contextual environment of care, competing responsibilities of care, awareness of responsibility for safety, and interprofessional communication. Contextual environment of care was affected by time pressure and efficiency, and an overriding priority to move patients out of emergency departments. In competing responsibilities of care, a reactive focus was displayed in emergency departments while a proactive stance was demonstrated in medical wards. There was an awareness of responsibility for safety, whereby key stakeholders appreciated the chain of events involved, interpersonal communication affected patients and carers, and consequences existed for patient education related to lack of information. Interdisciplinary communication was associated with communication modalities used in encounters, compartmentalised thinking, and medicines changes relayed to external providers. Conclusions Medicines management at transition points involved a complex interplay of dynamic features. This interplay infiltrated across diverse environments, affecting patient care within and outside hospitals. Relevance to clinical practice Health professionals require greater appreciation of each other's roles at transition points of care. Prioritisation of high‐risk patients is needed, such as those with cognitive impairment and multiple co‐morbidities. Establishing workable protocols of communication etiquette and a structured approach to medicines activities may assist in pre‐empting problems before they occur.