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Medication decision-making on hospital ward-rounds.
Melissa Baysari1, Johanna Westbrook, Richard Day
1Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Studies in Health Technology and Informatics
|September 7, 2011
Summary
Shared decision making (SDM) in medicine selection during hospital ward rounds is rare. Most medication discussions occur between doctors, not involving patients, and decision support tools have minimal impact.
Area of Science:
- Medical Practice
- Health Services Research
- Clinical Decision Making
Background:
- Shared decision making (SDM) is recognized as a key component of patient-centered care.
- However, its implementation in routine hospital ward rounds, particularly concerning medication selection, remains under-explored.
Purpose of the Study:
- To investigate the dynamics of medication decision-making during hospital ward rounds.
- To determine the extent of shared decision making (SDM) between doctors and patients.
- To assess the influence of limited computerized decision support on these discussions.
Main Methods:
- Observational study involving shadowing of 14 specialty teams (46 doctors) during hospital ward rounds.
- Systematic recording of all verbal communication pertaining to medications.
- Analysis of the context (patient presence, participants) and nature of medication discussions.
Main Results:
- Most medication discussions occurred between two or more doctors, predominantly away from the patient's bedside.
- While doctors communicated frequently with patients about medications, true shared decision making (SDM) was infrequent.
- Doctors often informed patients about prescribed or current medications rather than engaging in collaborative decision-making.
- The low-level computerized decision support system had a negligible impact on treatment decision-making processes.
Conclusions:
- Shared decision making (SDM) is rarely practiced during hospital ward rounds, despite its acknowledged importance.
- Current practices favor a more paternalistic approach where doctors primarily inform patients about medication choices.
- Further interventions are needed to promote SDM in inpatient settings.
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