| Characteristics of patients |
“difficult and demanding” [59]; “nattering in your ear” [59]; “poor levels” of comprehension [65]; “diffic-ulty hearing” [58]; “do not remember” [58,63]; “memory deficits and multiple comorbidities” [60]; present with “routine issues” [59]; “battery of symptomology” [59]; “not sure what medication they needed” [65] |
“Obstacles for adherence” [62]; “desires to continue to take” medication despite “may have long-term side effects” [60]; in older people “the benefit of preventative medicine may not exceed risks” [62]; reception-ists “more likely to make an error” as a result of deficiencies in older patients’ medication requests [65] |
| Relationships between primary health care staff |
“reluctant to question GPs”; assumed “medication counselling from the GP”; “negative experiences”; “asymmetrical relationships” [58]; “role of their peers in maintaining safe practice”; “the extent to which both parties are willing to collaborate over safety-related issues” [66]; fear of blame [66]; “the level of professional trust that they have in each other” [66]; “benefits of developing a culture in which incidents were openly discussed and lessons shared and acted upon” [66]; “Knowledge about colleagues’ reasons for prescriptions was … difficult to obtain” [62]; “safety … assured … by an environment of effective, two way, and blame free communication” [64]; “poor communication and nurses’ ‘quasiautonomous role’”; “the importance of … being able to share anxieties or worries” [59]; ambiguous wording of hospital letters” [59] |
“time taken to contact GPs”[58]; “community pharmacists lacked access to patients’ medical records”[58]; perceived “deficiencies in the performance of clinicians” [64]; GPs “had little information about medical indications for or changes to the drug list” [63]; “the real time activity and collaboration that actually unfolds around repeat prescribing, which is typically messy and unpredictable” [64]; “the difficulties of coordination between multiple institutions can lead to dire consequences” [60]; “dialogue was more direct when pharmacists were located in the same clinic” [60]; “e-prescribing led to … less conversation between the pharmacy and the prescriber’s office” [67]; “with little or no information” [59] |
| Comm-unication between patients and staff |
A strategy “to create a feeling of safety” involved “interviewing patients about what other drugs they were taking … and asking patients to return if they felt unwell after taking the medication” [63]; receptionists mediate communication between patients and doctors [65]; “Difficulties in communicating”; telephone communication “a source of error”[65] |
“pressure to turn around medicines quickly for the customer” [66]; “lack of time during consultations” [62]; e-prescribing meant pharmacists “remembered less about their patients” [67]; updating computer records can “fall through the net” [59]; “patients frequently call outside of the times allocated” [65] |
| Knowledge |
“knowledge of the patient”; “perception of risk” “influenced by whether the GP was aware of having made an error in the past” [59]; “caution when using new, unusual or unfamiliar drugs” [59]; “many guidelines were perceived as too rigid” [62]; “anxiety appears when the GP’s conviction conflicts with either that of a specialist or the guidelines” [62]; “the organisation may have mechanisms for sharing resources and knowledge” [66]; patients with “knowledge gaps about medication”; “insufficient patient counselling about medication” [58] |
“difficulties in accessing complex medical and medication histories in” EHRs; EHRs “did not link patient diagnoses and blood test results to prescribed medication” [58]; lack of evidence and information in drug alerts led to “cynicism” [61]; “some medi-cation alerts may not be supported by pharmacy data” [61]; “With as few as 3 medicines, most GPs felt that they were on thin ice” [62]; “an environ-ment that mixes drugs’ generic and trade names” [60]; “since e-prescrip-tions were sent directly to pharmacies, patients “were not reminded what medications they were being prescri-bed” [67]; “therapeutic training”; “drug knowledge and experience”; “picked up on the job” [59]; “importance of hands-on training” [59]; “severity of potential adverse drug effects” [59] |
| Responsibility |
A tension between GP’s and patient’s responsibility for patient health [59]; locums “unwilling to take” responsibility [59]; “the locum pharmacist talks of his disconnect from the day-to-day activity of the pharmacy” [58]; “risk of disciplinary action or litigation should a patient be harmed” [66]; “a tendency to attribute blame to individuals unnecessarily” [66]; “doctor controlled and non-negotiable” [64]; reception staff “informally accountable” [64]; need “to get patients more involved in their own treatment” [63]; “feel more responsibility to elderly patients who take many different medications” [63]; GPs “felt they had another prescriber’s responsibility dumped on them” [63]; “patient as safety barrier” could “erode patients’ trust in the pharmacy” [66]; “at risk of being reported by patients for malpractice” [62] |
“the GP’s signature holds considerable power” [65]; “ambiguities around the lack of a generally-recognized individual accountable for addressing ADRLLs” [60]; “no adequate system”; “their own limited ad hoc approaches”; “obscure medications” “prescribed infrequently” [60]; “signing drug lists for conditions that were beyond their competence to manage” [63]; “taking responsibility for all drugs prescribed to a patient was viewed as an impossible task” [63]; a conflict “between ‘doing the right thing’ and staying within legal boundaries” [66]; “level of trust in governance processes depends on who is administering them” [66]; governance should support “development of practice rather than sanctioning individuals or sites” [66]; “insufficient knowledge”; unfamiliar “with the potential side effects”; “assumed that they knew enough” [58] |
| Workflow |
“hidden” work bridges the model-reality gap [64]; “non-adherence” to guidelines and systems “to address workload and minimise errors” [65]; “Tiredness and anxiety” [59] |
Time pressure; constraints on space [64]; need to defer monitoring adverse drug reactions “to address more press-ing issues”; workload a “prominent barrier” [60] (& [62]); electronic prompts and reminders “interrupted … workflow and were not helpful”; “reminder fatigue” [60] (& [61]); “now more focused on fixing problems with e-prescriptions” than other matters [67]; “potential for GPs to be distracted and interrupted” [59]; “increased likelihood of error when staff were rushing”; guidelines “fall down when the surgery [is] busy”; lack of space, facilities or time for monitoring medications; system for sharing workload “introduced new stages for potential errors to occur” [65] |
