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    Gaps, traps, bridges and props: a mixed-methods study of resilience in the medicines management system for heart failure patients at hospital discharge

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    Publication date
    2019-02
    Author
    Fylan, Beth
    Marques, Iuri
    Ismail, Hanif
    Breen, Liz
    Gardner, Peter H.
    Armitage, Gerry R.
    Blenkinsopp, Alison
    Keyword
    Patient safety
    Resilience
    Cardiology
    Medicines management
    Rights
    (c) 2019 The Authors. This is an Open Access article distributed under the Creative Commons CC-BY license (https://creativecommons.org/licenses/by/4.0/)
    Peer-Reviewed
    Yes
    
    Metadata
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    Abstract
    Poor medicines management places patients at risk, particularly during care transitions. For patients with heart failure (HF), optimal medicines management is crucial to control symptoms and prevent hospital readmission. This study explored the concept of resilience using HF as an example condition to understand how the system compensates for known and unknown weaknesses. We explored resilience using a mixed-methods approach in four healthcare economies in the north of England. Data from hospital site observations, healthcare staff and patient interviews, and documentary analysis were collected between June 2016 and March 2017. Data were synthesised and analysed using framework analysis. Interviews were conducted with 45 healthcare professionals, with 20 patients at three timepoints and 189 hours of observation were undertaken. We identified four primary inter-related themes concerning organisational resilience. These were named as gaps, traps, bridges and props. Gaps were discontinuities in processes that had the potential to result in poorly optimised medicines. Traps were features of the system that could produce errors or unintended adverse medication events. ‘Bridges’ were features of the medicines management system that promoted safety and continuity which ensured that, despite varying conditions, care could be delivered successfully. ‘Props’ were informal, temporary or impromptu actions taken by patients or healthcare staff to avoid potential adverse events. The numerous opportunities for HF patient safety to be compromised and sub-optimal medicines management during this common care transition are mitigated by system resilience. Cross-organisational bridges and temporary fixes or ‘props’ put in place by patients and carers, healthcare teams and organisations are critical for safe and optimal care to be delivered in the face of continued system pressures.
    URI
    http://hdl.handle.net/10454/16745
    Version
    Published version
    Citation
    Fylan B, Marques I, Ismail H et al (2019) Gaps, traps, bridges and props: a mixed-methods study of resilience in the medicines management system for heart failure patients at hospital discharge. BMJ Open. 9(2): e023440.
    Link to publisher’s version
    https://doi.org/10.1136/bmjopen-2018-023440
    Type
    Article
    Collections
    Life Sciences Publications

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