A qualitative systemic analysis of drug dispensing in Swiss hospital wards
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Objective The traditional floor stock drug distribution system entails that, in most Swiss hospitals, drugs are prepared in a pillbox for each patient by nurses before administration. The aim of this study was to analyse and evaluate the process of inpatient pillbox dispensing in Switzerland. Setting Internal medicine wards in three regional hospitals (32–39 beds). Method A qualitative exploratory study with 4 days of participant observation and three semi-structured interviews on each of the three wards. Main outcome measure Thematic content analysis of observations, casual conversations and semi-structured interviews. Results Pillboxes are prepared in a somewhat tumultuous context. The space for preparation is not isolated from health carers’ other activities which makes it prone to numerous interruptions. Drug blisters and tablets often lack the necessary inscriptions to identify them as unit doses. Storage places are small and unstructured. Nurses have to translate medical orders into the name and dosage of the hospital formulary drugs. Use of patients’ own drugs hampers both storage and preparation. Nurses take easily a task over one from another, which affects continuity. Practices vary and few standard rules have been set. The position of nurses in the medication process makes them routinely compensate for failures and gaps from healthcare workers involved in the upper stream of their tasks, without any opportunity of giving some feedback. Conclusion The preparation of a pillbox is error prone not only because single doses of oral drugs are not identifiable in a safe way, but also because of various context-related factors. The latter can be grouped into four categories that are linked in a dynamic relationship: tools, practices, organization and information transmission. Improvement strategies should consider all four categories as well as the specific position of nurses in the medication process which makes them fundamental guarantors of the system resilience.
KeywordsDrug dispensing Hospital pharmacy Medication safety Nurses Pillbox dispensing Qualitative study Floor stock distribution Switzerland
We are grateful to all the nurses who took part in this research, as well as the head nurses, medical doctors and hospital managers who opened the doors of their wards to us. We would like to thank the Research Funds of the Pharmacie des Hôpitaux du Nord Vaudois et de la Broye (PHNVB) for granting financial support for this study.
The research was funded by the Research Funds of the PHNVB.
Conflict of interests
None to declare.
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