SPECIAL SESSION: Towards Improved Safety by Examining the Complexities of Health Care

Description/Overview: The overarching theme of this special session is the need to consider the complexities of health care practice in order to make a difference and improve care. The focus of this special session is to examine three main areas of my research. These three areas comprise: communication in health care, medication adherence and patient safety. My work on communication in health care has involved the use of audio-recording and video-recording observations of how patients, family members, and health professionals interact with each other about managing medications in hospital settings. Critical ethnography has been effectively used in examining communication processes in ward rounds, handovers and informal interactions has contributed to repositioning and shifting researchers’ and health professionals’ thinking about the importance of observing actual clinical practice. Knowledge gained on these real experiences has been fed back to nurses and other health professionals in hospitals at the local level and contributed to changes in health professionals’ thinking and in medication activities. My communication research into medications has culminated in the development and publication of a conceptual framework on medication communication. This framework delineates the link between medication management and communication. It provides a structured approach in examining the defining attributes, environmental and sociocultural influences, and consequences of communication. In the area of medication adherence, I have collaborated to develop novel, consumer-centred interventions aimed at improving blood pressure and medication adherence for consumers with diabetic-kidney disease of English speaking and non-English speaking backgrounds, and consumers with osteoarthritis and other chronic conditions. These interventions have included video-recorded information of the barriers to medication-taking experienced by consumers and steps they have taken to resolve these barriers. Implementation of these interventions have led to improved medication-taking behaviours, better blood pressure control and improved patient engagement with health professionals about how to manage medications more effectively at home. Research in patient safety has involved development and evaluation of three risk screening tools: self-administration of medication by patients in hospital; the risk of representation to the emergency department by homeless people; and the risk of medication mismanagement by people of non-English speaking backgrounds. Prior to developing these tools, interviews and focus groups have been undertaken with patients and health professionals to determine their perspectives of the particular issue. Audits have been conducted to determine the effects of explanatory variables on outcomes variables. The resulting tools have been tested in the actual environments in which they are to be used, thereby enabling utility to be measured. These tools are used by nurses who work in rehabilitation units, outpatient units and emergency departments.