Publications
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Subakumar K, Franklin BD, Garfield S, 2021, Analysis of the third WHO Global Safety Challenge 'Medication Without Harm' patient-facing materials: exploratory descriptive study, EUROPEAN JOURNAL OF HOSPITAL PHARMACY, Vol: 28, Pages: E109-E114, ISSN: 2047-9956
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Grimes TC, Garfield S, Kelly D, et al., 2020, Household medication safety practices during the COVID-19 pandemic: a descriptive qualitative study protocol, BMJ Open, Vol: 10, Pages: 1-6, ISSN: 2044-6055
Introduction Those who are staying at home and reducing contact with other people during the COVID-19 pandemic are likely to be at greater risk of medication-related problems than the general population. This study aims to explore household medication practices by and for this population, identify practices that benefit or jeopardise medication safety and develop best practice guidance about household medication safety practices during a pandemic, grounded in individual experiences.Methods and analysis This is a descriptive qualitative study using semistructured interviews, by telephone or video call. People who have been advised to ‘cocoon’/‘shield’ and/or are aged 70 years or over and using at least one long-term medication, or their caregivers, will be eligible for inclusion. We will recruit 100 patient/carer participants: 50 from the UK and 50 from Ireland. Recruitment will be supported by our patient and public involvement (PPI) partners, personal networks and social media. Individual participant consent will be sought, and interviews audio/video recorded and/or detailed notes made. A constructivist interpretivist approach to data analysis will involve use of the constant comparative method to organise the data, along with inductive analysis. From this, we will iteratively develop best practice guidance about household medication safety practices during a pandemic from the patient’s/carer’s perspective.Ethics and dissemination This study has Trinity College Dublin, University of Limerick and University College London ethics approvals. We plan to disseminate our findings via presentations at relevant patient/public, professional, academic and scientific meetings, and for publication in peer-reviewed journals. We will create a list of helpful strategies that participants have reported and share this with participants, PPI partners and on social media.
Garfield S, Furniss D, Husson F, et al., 2020, How can patient-held lists of medication enhance patient safety? A mixed-methods study with a focus on user experience, BMJ Quality & Safety, Vol: 29, Pages: 764-773, ISSN: 2044-5415
Background Patients often carry medication lists to mitigate information loss across healthcare settings. We aimed to identify mechanisms by which these lists could be used to support safety, key supporting features, and barriers and facilitators to their use.Methods We used a mixed-methods design comprising two focus groups with patients and carers, 16 semistructured interviews with healthcare professionals, 60 semistructured interviews with people carrying medication lists, a quantitative features analysis of tools available for patients to record their medicines and usability testing of four tools. Findings were triangulated using thematic analysis. Distributed cognition for teamwork models were used as sensitising concepts.Results We identified a wide range of mechanisms through which carrying medication lists can improve medication safety. These included improving the accuracy of medicines reconciliation, allowing identification of potential drug interactions, facilitating communication about medicines, acting as an aide-mémoire to patients during appointments, allowing patients to check their medicines for errors and reminding patients to take and reorder their medicines. Different tools for recording medicines met different needs. Of 103 tools examined, none met the core needs of all users. A key barrier to use was lack of awareness by patients and carers that healthcare information systems can be fragmented, a key facilitator was encouragement from healthcare professionals.Conclusion Our findings suggest that patients and healthcare professionals perceive patient-held medication lists to have a wide variety of benefits. Interventions are needed to raise awareness of the potential role of these lists in enhancing patient safety. Such interventions should empower patients and carers to identify a method that suits them best from a range of options and avoid a ‘one size fits all’ approach.
Garfield S, Teo V, Chan L, et al., 2020, To what extent is the World Health Organization's medication safety challenge being addressed in English hospital organizations? a descriptive study., Journal of Patient Safety, ISSN: 1549-8417
OBJECTIVES: Our study aimed to explore to what extent the priority areas and domains of the World Health Organization (WHO)'s third Global Patient Safety Challenge were being addressed in a sample of hospital organizations. METHODS: A qualitative approach was taken using a combination of focus groups, semistructured interviews, and documentary analysis in 4 UK teaching hospital organizations. A purposive sampling strategy was adopted with the aim of recruiting health care professionals who would be likely to have knowledge of medication safety interventions that were being carried out at the hospital organizations. Medication safety group meeting notes from 2017 to 2019 were reviewed at the hospital organizations to identify interventions recently implemented, those currently being implemented, and plans for the future. A content analysis was undertaken using the WHO's third Global Patient Safety Challenge priority areas and domains as deductive themes. RESULTS: All the domains and priority areas of the WHO Medication Safety Challenge were being addressed at all 4 sites. However, a greater number of interventions focused on "health care professionals" and "systems and practices of medication management" than on "patients and the public." In terms of the priority areas, the main focus was on "high-risk situations," particularly high-risk medicines, with fewer interventions in the areas of "transitions of care" and "polypharmacy." CONCLUSIONS: More work may be needed to address patient and public involvement in medication safety and the priority areas of transitions of care and polypharmacy. Comparative global studies would help build an international picture and allow shared learning.
Bell H, Garfield S, Khosla S, et al., 2019, Mixed methods study of medication-related decision support alerts experienced during electronic prescribing for inpatients at an English hospital, European Journal of Hospital Pharmacy: Science and Practice, Vol: 26, Pages: 318-322, ISSN: 2047-9956
Objectives Electronic prescribing and medication administration systems are being introduced in many hospitals worldwide, with varying degrees of clinical decision support including pop-up alerts. Previous research suggests that prescribers override a high proportion of alerts, but little research has been carried out in the UK. Our objective was to explore rates of alert overriding in different prescribing situations and prescribers’ perceptions around the use of decision support alerts in a UK hospital.Methods We conducted a mixed methods study on three cardiology wards, directly observing medical and non-medical prescribers’ alert override rates during both ward round and non-ward round prescribing; observations were followed by semi-structured interviews with prescribers, which were then transcribed and analysed thematically.Results Overall, 69% of 199 observed alerts were overridden. Alerts experienced during ward rounds were significantly more likely to be overridden than those outside of ward rounds (80% of 56 vs 51% of 63; p=0.001, Χ2 test). While respondents acknowledged that alerts could be useful, several also described negative unintended consequences. Many were of the view that usefulness of alerts was limited if the alert was reminding them to do something they would do anyway, or suggesting something they did not feel was relevant. Findings suggest that targeting, timing and additional features of alerts are critical factors in determining whether they are acted on or overridden.Conclusion The majority of alerts were overridden. Alerts may be less likely to be overridden if they are built into the prescribing workflow.
Ocloo J, Garfield S, Dawson S, et al., 2017, Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a protocol for a systematic review of reviews, BMJ Open, Vol: 7, Pages: 1-6, ISSN: 2044-6055
Introduction The emergence of patient and public involvement (PPI) in healthcare in the UK can be traced as far back as the 1970s. More recently, campaigns by harmed patients and their relatives have emerged as a result of clinical failings in the NHS, challenging paternalistic healthcare, which have led to a new focus on PPI in quality and safety, nationally and internationally. Evidence suggests that PPI within patient safety is often atheoretical and located within a biomedical discourse. This review will explore the literature on PPI across patient safety, healthcare and social care to identify theory, barriers and enablers that can be used to develop PPI in patient safety.Methods and analysis Systematic searches of three electronic bibliographic databases will be conducted, using both MeSH and free-text terms to identify empirical literature published from database inception to May 2017. The screening process will involve input from at least two researchers and any disagreement will be resolved through discussion with a third reviewer. Initial inclusion and exclusion criteria have been developed and will be refined iteratively throughout the process. Data extraction from included articles will be conducted by at least two researchers using a data extraction form. Extracted information will be analysed using a narrative review approach, which synthesises data using a descriptive method.Ethics and Dissemination No ethical approval is required for this review as no empirical data were collected. We believe that the findings and recommendations from this review will be particularly relevant for an audience of academics and policymakers. The findings will, therefore, be written up and disseminated in international peer-reviewed journals and academic conferences with a health focus. They will also be disseminated to leading health policy organisations in the NHS, such as NHS England and NHS Improvement and national policy bodies such as the Health Foundation.
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