Table 2. Practice-specific facilitators and barriers of medication safety practices (n=67) implementation reported by the hospitals participating in the study (n=55).

Practice	Barriers	Facilitators
Safety vest (n=16)*	• Difficulties to commit the staff to use of the vest. • Negative attitudes against wearing the vest. •Wearing safety vest may be experienced as disturbing. • Nurses like to be available for questions and they think the vest will prevent it. • The staff would like to use other methods to make medication dispensing more peaceful. • The vest does not stop the primary cause of interruptions (e.g. phone calls). • The meaning of peace at work is hard to understand for the staff. • Vest material unsuitable for hospital use. • Infection control concerns when sharing the vests between many healthcare professionals. • The costs of the vests more than expected. • Some relatives of patients are embarrassed to ask help from a nurse wearing the vest even if they have no choice. • Some relatives see the vest as an “alert” and the nurse wearing the vest is interrupted more often than nurses without it.	• Ongoing reminders to use the vest.
Medication reconciliation (n=28)*	• No electronic patient records are available or part of the prescriptions are handwritten. • Electronic patient records do not support medication reconciliation procedure or the actors (e.g. nurse, pharmacist, doctor) have insufficient skills to use the electronic records. • Incomplete patient records and medication documentation (e.g. previous medications). • Individual patient medication continuation depends on the specialty or interests of the unit. • No procedure what to do if there is something wrong in patient’s medication. • Difficult to share medication information and organize coordination of medication reconciliation procedure between pharmacists, doctors, nurses and patients. • Time-consuming procedure and/or it takes more time than anticipated. • The doctors and patients are dependent of the presence of pharmacist at the unit and there are limited number of pharmacists in the organization. • Discharges are sometimes fast or unplanned, and may take place when pharmacist is not present at the unit. Patient will leave or medicines are sent to patient’s home before pharmacist has a chance to check the medication. • Difficulties in presenting the reconciliation process to patient in a simple way. • The reconciliation process (at admission and discharge) is not completed if the patient is moving to next ward where there is no possibility to pharmacist’s intervention. • Lack of available space for patient medication overview discussions. • Workload not evenly spread throughout the week. • Difficulties to commit doctors for the practice and to describe medication reconciliation benefits for patients and healthcare professionals. • Patient feels uncomfortable when a large number of professionals are asking them about their medications. • Pharmacy technicians’ skills and role unexploited. • Problems to send discharge letters to GPs in relevant time. • Lack of guidelines to medication reconciliation.	• Electronic patient records which support medication reconciliation process are in use. • Other pharmacist services already available in unit and/or medication reconciliation is part of pharmacist’s normal visit to wards. • The presence of pharmacist is appreciated by doctors. • There is regional standards and cooperation for medication reconciliation.
Medication list (n=8)*	• No electronic patient record system available. • Difficulties to bring together all the actors (e.g. nurses, pharmacists and doctors) and to find agreement on the practice procedure with doctors. • After procedure agreement all the actors do not involve in the process (especially doctors). • Doctors and patients are dependent of the presence of pharmacist at the unit. • Difficulties in presenting the medication list to patient in an understandable way.	• Already existing clinical pharmacy services in the unit. • Already existing medication reconciliation process in the unit. • The presence of pharmacist appreciated by doctors.
Bed dispensing (n=13)*	• "Staff - bottleneck" (e.g. number of nursing staff at the time of sick leaves). •  Lack of space for medication carts at the wards. • The financial costs of the carts. •  Non - acceptance by nurses to change the traditional style to dispense medicines.	• Electronic prescription and patient records in use (if computers available for carts).

*n=hospitals involved in implementation