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Interdisciplinary medication decision making by pharmacists in pediatric hospital settings: An ethnographic study
Ellie Rosenfeld1, Sharon Kinney2, Carlye Weiner1
1Department of Nursing, The University of Melbourne, 161 Barry Street, Parkville, VIC, 3052, Australia.
Insights
Pharmacists are crucial in pediatric hospital medication decisions, collaborating with doctors and nurses to resolve complex issues and prevent errors. Their expertise significantly enhances patient safety in pediatric care settings.
Area of Science:
- Pediatric Pharmacy Practice
- Interprofessional Collaboration
- Medication Safety
Background:
- Children face unique risks of medication incidents in hospitals.
- Pharmacists' roles in reducing pediatric medication errors are well-documented, but less is known about interdisciplinary interactions.
- Understanding these interactions is key to optimizing medication decision-making in pediatric settings.
Purpose of the Study:
- To examine the interdisciplinary medication decision-making processes involving pharmacists in pediatric hospital environments.
- To explore the specific contributions and interactions of pharmacists with other healthcare professionals in resolving medication issues.
Main Methods:
- An ethnographic study design was employed.
- Data collection included observations, semi-structured interviews, and focus groups.
- Thematic analysis was used to analyze audio-recorded data.
Main Results:
- Pharmacists played a central role in complex pediatric medication decisions, intervening on dosage, administration, and drug interactions.
- Healthcare staff frequently sought pharmacists' expertise for medication advice, particularly for off-label prescribing, ambiguous protocols, and polypharmacy.
- Strong interprofessional relationships facilitated pharmacists' interventions, though staffing limitations posed challenges.
Conclusions:
- Pharmacists make significant and valued contributions to interprofessional medication decision-making in pediatric settings.
- This research provides novel insights into the pharmacist's role in collaborative medication management and decision-making.
- Findings can inform theoretical advancements regarding pharmacists' contributions to patient safety in pediatric care.
Objective:
Children are particularly vulnerable to experiencing medication incidents in hospitals. Making sound medication decisions is therefore of paramount importance. Prior research has principally described pharmacists' role in reducing medication errors. There is a dearth of information about pharmacists' interactions with pediatric hospital staff across disciplines in resolving medication issues. The aim of this study was to examine interdisciplinary medication decision making by pharmacists in pediatric hospital settings.
Design:
An ethnographic design was undertaken comprising observations, semi-structured interviews and focus groups. Audio-recorded data were analyzed thematically.
Setting:
The study was conducted in three wards of an Australian pediatric tertiary teaching hospital, comprising general surgical, gastroenterology, endocrinology, neurology, adolescent and rehabilitation settings.
Participants:
Pharmacists, registered nurses and doctors were recruited from diverse clinical wards following information sessions.
Results:
Pharmacists were central to complex pediatric medication decision making, intervening about dosage, administration, drug interactions and authorities. Pharmacists proactively contacted doctors and nurses about prescribing issues; conversely, staff routinely approached pharmacists for medication advice. Pharmacists were perceived as medication experts, their extensive knowledge valued in resolving complex issues: when off-label medications were prescribed, when protocols were absent or ambiguous, where tension existed between protocol adherence and patient safety, and where patients on multiple medications were at risk of medication error. Pharmacists had strong relationships with doctors and nurses, which had a bearing on pharmacists' input in interventions. Furthermore, pharmacists identified prescribing errors through strategies, such as case note review and medication reconciliation, although the lack of emergency department pharmacists and limited after-hours staffing posed challenges to both strategies.
Conclusions:
Pharmacists made a substantial and highly valued contribution to pediatric inter-professional medication decision making. These results provide new knowledge that informs theoretical developments of pharmacists' role in decision making.