Communication and collaboration: It's about the pharmacists, as well as the physicians and nurses
Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. Quality and Safety in Health Care
(Impact Factor: 2.16).
06/2010; 19(3):169-72. DOI: 10.1136/qshc.2008.026435
Collaboration and communication as dimensions of patient safety climate have been measured in acute care hospital units, and discrepant viewpoints have been documented between different professional groups, particularly between physicians and nurses. In the ambulatory care setting, these groups often work more closely together throughout the day than in acute care settings, thereby enhancing effective collaboration and communication. This study sought to determine if the communication differences that are known to impact patient safety, which are found in acute care, also exist in ambulatory care.
The Safety Attitudes Questionnaire, a 77-item survey of collaboration, communication and safety attitudes, was administered to the primary care staff at four Midwestern military ambulatory care clinics.
There were 107 participants consisting of nurses (n=46), nurse practitioners (n=12), pharmacists (n=10) and physicians (n=39), yielding an overall response rate of 65%. All groups rated their peer group higher than other professional groups. The ratings of nurses and physicians were very similar: 85.0% of nurses rated physicians, and 85.7% of physicians rated nurses as high or very high in communication and collaboration. Pharmacists were rated the lowest by each of the other professional groups. Only 60% of pharmacists rated physicians as high or very high.
Collaboration and communication ratings among physicians and nurses appear to be higher in the ambulatory care setting than in the acute care. However, interactions with pharmacists are more problematic, perceived as adversarial. Teamwork training that focuses on specific interactions among professional groups should target these concerns.
Available from: Verena Schadewaldt
- "While some MPs agreed that collaboration can exist as true reciprocity they rather acknowledged that forms of collaboration range from an interdependent to hierarchical relationship . Contrary to some of these findings, NPs and MPs rated their working relationships with each other as collegial  and their level of collaboration and communication as high  when measured on attitude scales. "
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ABSTRACT: This integrative review synthesises research studies that have investigated the perceptions of nurse practitioners and medical practitioners working in primary health care. The aggregation of evidence on barriers and facilitators to working collaboratively and experiences about the processes of collaboration is of value to understand success factors and factors that impede collaborative working relationships.
An integrative review, which used systematic review processes, was undertaken to summarise qualitative and quantitative studies published between 1990 and 2012. Databases searched were the Cochrane Library, the Joanna Briggs Institute Library, PubMed, Medline, CINAHL, Informit and ProQuest. Studies that met the inclusion criteria were assessed for quality. Study findings were extracted relating to a) barriers and facilitators to collaborative working and b) views and experiences about the process of collaboration. The findings were narratively synthesised, supported by tabulation.
27 studies conducted in seven different countries met the inclusion criteria. Content analysis identified a number of barriers and facilitators of collaboration between nurse practitioners and medical practitioners. By means of data comparison five themes were developed in relation to perceptions and understanding of collaboration. Nurse practitioners and medical practitioners have differing views on the essentials of collaboration and on supervision and autonomous nurse practitioner practice. Medical practitioners who have a working experience with NPs express more positive attitudes towards collaboration. Both professional groups report concerns and negative experiences with collaborative practice but also value certain advantages of collaboration.
The review shows that working in collaboration is a slow progression. Exposure to working together helps to overcome professional hurdles, dispel concerns and provide clarity around roles and the meaning of collaboration of NPs and MPs. Guidelines on liability and better funding strategies are necessary to facilitate collaborative practice whether barriers lie in individual behaviours or in broader policies.
Available from: Swee C. Goh
- "As indicated earlier, a teamwork and collaborative work environment increases knowledge sharing and a safe group environment to deal with adverse events and for reporting failures. Therefore, teamwork and collaboration could also have a positive impact on patient safety culture and organizational learning (Berta and Baker, 2004; Holden et al., 2010). Organizational support structures such as providing training and knowledge of working in teams and a non-hierarchical organization design are also needed to develop learning capacity. "
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ABSTRACT: This article aims to encourage healthcare administrators to consider the learning organization concept and foster collaborative learning among teams in their attempt to improve patient safety.
Relevant healthcare, organizational behavior and human resource management literature was reviewed.
A patient safety culture, fostered by healthcare leaders, should include an organizational culture that encourages collaborative learning, replaces the blame culture, prioritizes patient safety and rewards individuals who identify serious mistakes.
As healthcare institution staffs are being asked to deliver more complex medical services with fewer resources, there is a need to understand how hospital staff can learn from other organizational settings, especially the non-healthcare sectors.
The paper provides suggestions for improving patient safety which are drawn from the health and business management literature.
Available from: factsandcomparisons.com
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ABSTRACT: MEDICATION SAFETY Overlooked Renal Dosage Adjustments A retrospective analysis of 647 patients at hospital discharge com-pared required renal dosage adjust-ments to dosage actually prescribed. This study was conducted at VieCuri Medical Centre in Venlo, Netherlands. Patient demographics and renal function data were col-lected, and dosage adjustment needs were assessed via the pharmacy-supported discharge counseling ser-vice. The incidence of inappropriate dosing based on renal function was measured at hospital discharge. Thirty-seven percent of patients evaluated during the study period (237/647) had a creatinine clear-ance less than 51 mL/min/1.73 m 2 ; dosage adjustment was warranted in 23.9% (411/1,718) of prescrip-tions. When dosage adjustment should have been performed, more than 40% of prescriptions (169/411; 41.1%) were inappropri-ate for renal function (9.8% of pre-scriptions overall; 169/1,718). Fur-thermore, 60.4% (102/169) of inappropriate prescriptions pos-sessed the potential for moderate or severe clinical consequences, as evaluated by a panel of two clinical pharmacologists and one nephrolo-gist. Study authors also noted a lack of standardized dosing guidelines for agents requiring renal dosage adjustment. The authors also sug-gested that augmenting medication systems by adding dynamic renal dosing alerts would improve moni-toring. Summary: A comparison of suggested renal dosing and actual dosing at hospital discharge revealed that appropriate prescribing may be overlooked. van Dijk EA, Drabbe NRG, Kruijtbosch M, De Smet PAGM. Drug dosage adjust-ments according to renal function at hos-pital discharge. Ann Pharmacother. 2006;40:1254-1260.
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