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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3107 — Communication Patterns across Clinical Roles in Inpatient Settings: A Focus on Medication Conversations

Weir CR (IDEAS Center), Nebeker J (IDEAS Center), Barrus F (IDEAS Center), Pepper G (IDEAS Center)

Objectives:
The rate of ADEs in hospitalized patients ranges from 3% to 32% and a substantial cause of harm is due to ineffective coordination between physicians, nurses and pharmacists. Medication management is a complex clinical task requiring significant dependencies between clinical roles. The objectives of this study was to assess the rate of communication events overall, and the rate of medication communication events using a taxonomy based on Clark’s theory of Communication.

Methods:
Ethnographic observations were conducted on a 32-bed medical surgical inpatient ward and a 12-bed telemetry floor. Twelve residents, 8 clinical pharmacists and 19 nurses agreed to participate. Two-hour time slots were selected randomly between 6am and 10pm (n = 53). Data was collected on PC tablets. Observers recorded all interchanges, including computer, phone and verbal. Reliability kappas were acceptable (0.66 to 0.87). Medication exchanges were classified into subtopics. All ADE was noted, and who was informed was recorded.

Results:
Communication events averaged 38 events per session (physicians averaged 22/hr, nurses had 16/hr and pharmacists had 12/hr). Rates of verbal events varied across roles with nurses at 92%, physicians and pharmacists at 72% and 55% respectively. A social network analysis of exchange pairs indicated significant differences in patterns of interactions across roles. Nurses interacted most with patients, then other nurses, whereas pharmacists and physicians interacted most with physicians. The differences were highly significant (X2 = 245.32; p = 0.00). The nurses had the highest “betweenness” in the social network. Medication management was the most frequent topic (79% for physicians, 47% for nurses and 82% for pharmacists.) In addition, physicians expressed the most medication information needs, followed by pharmacists and then nurses. Identification of an ADE by pharmacy or medicine was rarely communicated to nursing (2/118 and 3/44), but all of the ADEs identified by nurses were communicated to the other roles (9/9).

Implications:
Communication events are highly frequent with medication topics being the most common. A significant asymmetry existed regarding the content, direction and frequency of communication between roles.

Impacts:
Medication management goals are not fully communicated across roles. Support for communication channels should target sharing more information about goals of care, ADEs and potential harm.


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