Medication communication during handover interactions in specialty practice settings

Aims and objectives: To investigate what and how medication information is communicated during handover interactions in specialty hospital settings.

Background: Effective communication about patients' medications between health professionals and nurses at handover is vital for the delivery of safe continuity of care.

Design: An exploratory qualitative design and observational study.

Methods: Participant observation was undertaken at a metropolitan Australian public hospital in four specialty settings: cardiothoracic care, intensive care, emergency care and oncology care. A medication communication model was applied to the data and thematic analysis was performed.

Results: Over 130 hours of observational data were collected. In total, 185 (predominately nursing) handovers were observed across the four specialty settings involving 37 nurse participants. Health professionals communicated partial details of patients' medication regimens, by focusing on auditing the medication administration record, and through the handover approach employed. Gaps in medication information at handover were evident as shown by lack of communication about detailed and specific medication content. Incoming nurses rarely posed questions about medications at handover.

Conclusions: Handover interactions contained restricted and incomplete medication information. Improving the transparency, completeness and accuracy of medication communication is vital for optimising patient safety and quality of care in specialty practice settings.

Relevance to clinical practice: For nurses to make informed and rapid decisions regarding appropriate patient care, information about all types of prescribed medications is essential, which is communicated in an explicit and clear way. Jargon and assumptions related to medication details should be minimised to reduce the risk of misunderstandings. Disclosure of structured medication information supports nurses to perform accurate patient assessments, make knowledgeable decisions about the appropriateness of medications and their doses, and anticipate possible adverse events associated with medications. In addition, benefits of patient and family member contributions in communicating about medications at handover should also be considered.