Embedding hospital-based medication review.

Area of Science:

• Practice Theory
• Sociology of Health
• Organizational Studies

Background:

• Hospital medication review is a critical process for patient safety.
• Understanding the practical embedding of such reviews is essential for effective implementation.
• Contradictions within professional practices can hinder or facilitate developmental processes.

Purpose of the Study:

• To explore the embedding of hospital-based medication review.
• To examine the conflictual and developmental nature of this practice.
• To analyze manifestations of contradictions in professional practices and local embedding processes.

Main Methods:

• Ethnographic methods were employed.
• Activity theory's notion of contradictions was used for analysis.
• Data included 290 hours of participant observation and 31 semi-structured interviews in Swedish hospitals.

Main Results:

• Medication review exhibits contested, fragmented, and distributed characteristics.
• Tensions arose from differing professional conceptualizations, interests, and appraisal of the new practice.
• Challenges in individual versus collective responsibility in multi-site work were identified, highlighting the need for continuous "repair" work.

Conclusions:

• A practice-theoretical approach offers a novel perspective on studying local embedding processes.
• Observing frontline clinicians' daily work reveals ongoing embedding processes.
• Contradictions inherent in routine work practices present opportunities for learning and improvement.