Improving medicines management using video-reflexive ethnography
Research type
Research Study
Full title
Improving medicines management across organizational boundaries using video-reflexive ethnography
IRAS ID
271048
Contact name
David Scott
Contact email
Sponsor organisation
University of Dundee
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
1 years, 11 months, 28 days
Research summary
Research Summary
Transitions in care between hospital and community settings can pose a risk to patient safety, particularly in the form of medication errors. Medicines reconciliation – the act of resolving discrepancies in medication lists – is recommended for all patients undergoing hospital admission, transfer, and discharge back into the community. However, current evidence indicates that medicines reconciliation can be challenging to implement. While the traditional approach to understanding and improving patient safety focuses on identifying and correcting medical errors, new research and improvement methods are helping to prevent errors occurring in the first place, as well as identifying examples of good practice that can be shared more widely. Video-reflexive ethnography (VRE) is a method that applies this new approach to improving patient care.
This project is a three-year, qualitative study investigating how VRE can be applied as an innovative research methodology and quality improvement tool to enhance medicines management across organizational boundaries.
There will be four components to this project:
(1) non-participant observation and video filming of medicines reconciliation practices in two hospital inpatient wards and a GP practice;
(2) semi-structured interviews with healthcare professionals from the three sites on their understanding of medicines reconciliation at care transitions;
(3) semi-structured interviews with patients at the GP practice on their experiences of medicines management during their recent discharge from hospital;
(4) video-reflexive focus groups with healthcare professionals at the three sites, in which edited video footage of everyday working practices will be screened to encourage discussion and reflection on existing good practices and areas for improvement.The results of this project will inform the development and implementation of future interventions to improve medicines management. Furthermore, it will explore the methodological strengths and challenges of using VRE to engage healthcare teams in quality improvement.
Summary of Results
Medicines reconciliation is a procedure for ensuring that medication records are transferred accurately when patients cross healthcare organizational boundaries (e.g., the primary-secondary care interface). However, previous research on the effectiveness of medicines reconciliation has concluded that its impact on clinical outcomes is uncertain, indicating that implementation may be at fault due to complex healthcare systems. This research project aimed to investigate how video-reflexive ethnography could be used to understand and improve medicines management across organizational boundaries. Video-reflexive ethnography is a research method that involves video filming of healthcare practices and showing the video footage to staff in reflective groups. The project involved a combination of direct observations, interviews, video filming and focus groups, each of which was carried out across two general practices in NHS Scotland. Focusing on the experiences of pharmacists and pharmacy technicians in their management of medicines across organizational boundaries, the project identified various challenges that obstructed interprofessional teamwork and consequently prevented them from managing medicines safely. Members of the pharmacy team were able to use the video filming as an opportunity to visualize previously unseen difficulties and identify possible ways in which current practices could be improved to address these issues. Potential healthcare improvements were recognized by the primary care staff themselves, leading to the development of locally-tailored solutions in a 'bottom-up' approach that could feasibly be tested in other healthcare settings.
REC name
East of Scotland Research Ethics Service REC 1
REC reference
19/ES/0140
Date of REC Opinion
20 Feb 2020
REC opinion
Further Information Favourable Opinion