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Pharmacy World & Science

, Volume 30, Issue 4, pp 343–352 | Cite as

A qualitative systemic analysis of drug dispensing in Swiss hospital wards

  • Amina GadriEmail author
  • Renaud Pichon
  • Georges L. Zelger
Research Article

Abstract

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.

Keywords

Drug dispensing Hospital pharmacy Medication safety Nurses Pillbox dispensing Qualitative study Floor stock distribution Switzerland 

Notes

Acknowledgements

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.

Funding

The research was funded by the Research Funds of the PHNVB.

Conflict of interests

None to declare.

References

  1. 1.
    Gala TM. Results of the European Association of Hospital Pharmacists Survey 2005. [Document on the Internet]. European Association of Hospital Pharmacists; 2005 [downloaded 2007 June]. Available from: http://www.eahponline.org/
  2. 2.
    Rüeger M, Muff P. Roulette russe au chevet du malade. [Russian roulette at patient’s bedside]. Soins Infirmiers 2004;3:48–51.Google Scholar
  3. 3.
    Brunel P, Robelin N. Etude comparative de deux méthodes de dispensation des médicaments: nominale journalière et globale hebdomadaire. [Comparative study of two drug dispensing methods: unit dose system and traditional weekly system.] J Pharm Clin 1995;14:262–8.Google Scholar
  4. 4.
    Taxis K, Dean B, Barber N. Hospital drug distribution systems in the UK and Germany – a study of medication errors. Pharm World Sci 1999;21(1):25–31.PubMedCrossRefGoogle Scholar
  5. 5.
    Dean BS, Allan EL, Barber ND, Barker KN. Comparison of medication errors in an American and a British hospital. Am J Health Syst Pharm 1995;52(22):2543–9.PubMedGoogle Scholar
  6. 6.
    Schmitt E. Unit-dose drug distribution systems: old-fashioned or safer ways for pharmaceutical care? Eur Hosp Pharm 2000;6(1):4–12.Google Scholar
  7. 7.
    Reason JT. Foreword. In: Bogner MS, editor. Human error in medicine. Hillsdale (NJ): Lawrence Erlbaum associates; 1994. p. vii–xv, ISBN 0-8058-1386-1.Google Scholar
  8. 8.
    Leape LL. The preventability of medical injury. In: Bogner MS, editor. Human error in medicine. Hillsdale (NJ): Lawrence Erlbaum associates; 1994. p. 13–25, ISBN 0-8058-1386-1.Google Scholar
  9. 9.
    Schmitt E. Le risque médicamenteux nosocomial – circuit hospitalier du médicament et qualité des soins. [Iatrogenic medication risk – hospital medication process and quality in care.] Paris: Editions Masson; 1999. p. 99–100, ISBN 2-225-83587-X.Google Scholar
  10. 10.
    Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events – implications for prevention. JAMA 1995;274:29–34.PubMedCrossRefGoogle Scholar
  11. 11.
    Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. JAMA 1995;274:35–43.PubMedCrossRefGoogle Scholar
  12. 12.
    Vincent CA. Analysis of clinical incidents: a window on the system not a search for root causes. Qual saf Health Care 2004;13:242–3.PubMedCrossRefGoogle Scholar
  13. 13.
    Gadri A, Pichon R, Zelger GL. Pilot project: factors contributing to unsafety in pillbox preparation for hospital inpatients [Poster]. In: 33th European Society for Clinical Pharmacy symposium, Prag; 2004.Google Scholar
  14. 14.
    Taxis K, Barber N. Ethnographic study of incidence and severity of intravenous drug errors. BMJ 2003;326:684–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Norstrom PE, Brown CM. Use of patients’own medications in small hospitals. Am J Health Syst Pharm 2002;59(4):349–54.PubMedGoogle Scholar
  16. 16.
    Reason JT. Human error: models and management. BMJ 2000;320:768–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Ducros M. La sécurité des soins infirmiers – Constatations empiriques, stratégie de gestion du risque et limites. [Safety of nursing care – empiric observations, strategy of risk management and limits.] Recherche en Soins Infirmiers 2000;62:144–7.PubMedGoogle Scholar
  18. 18.
    Bates DW. Using information technology to reduce rates of medication errors in hospitals. BMJ 2000;320:788–91.PubMedCrossRefGoogle Scholar
  19. 19.
    West E. Organizational sources of safety and danger: sociological contributions to the study of adverse events. Qual Health Care 2000;9:120–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Leape LL. Errors in medicine. JAMA 1994;272(23):1851–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Carthey J, de Leval MR, Reason JT. Institutional resilience in healthcare systems. Qual Health Care 2001;10:29–32.PubMedCrossRefGoogle Scholar
  22. 22.
    Hollenwäger M, Gadri A, Pichon R, Zelger GL. Quantification of discrepancies in transcription and pillbox preparation [Poster]. In: 35th European Society for Clinical Pharmacy symposium, Vienna; 2006.Google Scholar
  23. 23.
    Gadri A, Pichon R, Zelger GL. Pillbox preparation by nurses: a self administered survey. [Poster]. In: 35th European Society for Clinical Pharmacy symposium, Vienna; 2006.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Amina Gadri
    • 1
    Email author
  • Renaud Pichon
    • 1
  • Georges L. Zelger
    • 1
  1. 1.Pharmacie des Hôpitaux du Nord Vaudois et de la BroyeYverdon-les-BainsSwitzerland

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