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Nurse and senior patient

Doctoral defence of Tiina Syyrilä, MSc, RN, 21 April 2023: Medication incidents often linked to lack of communication

The doctoral dissertation in the field of Nursing Science will be examined at the Faculty of Health Sciences at Kuopio campus. The public examination will be streamed online.

What is the topic of your doctoral research? Why is it important to study the topic?

The subject of the thesis was Communication factors contributing to medication incidents in hospitals. This is a topical subject, as the WHO has estimated global medication incident related costs being 42 billion US dollars per year. Medication incidents may result in minor harm, injuries or even death to hospitalised patients. A plethora of studies in recent decades have shown that communication factors are some of the most common factors contributing to medication incidents. This has been recognized widely among health professionals, but the challenges continue. Research has been scarce on concrete communication factors or their frequency among health professionals. Thus, it was worth studying and describing concrete and detailed communication factors, to develop tools for measuring the frequencies of perceived communication challenges and to name the most frequent communication challenges based on the measuring. By this way it is possible to direct interventions to the most common communication challenges and to enhance medication safety.

What are the key findings or observations of your doctoral research?

A concept of communication factors contributing to medication incidents was described and a tool was developed for measuring prevalence of the communication factors. The most common challenges and solutions to enhance medication communication suggested by health professionals were described.

According to the analysis of medication incident reports, half of the communication challenges were due to lack of communication, whereas incorrect information was communicated more rarely. Surprisingly, based on the analysis of medication incident reports, communication challenges take place most often within units, either between nurses or between nurses and physicians. In contrast, previous studies have often reported communication challenges relating to patient transition or discharge situations between units or organizations.

Health professionals’ answers to the digital questionnaire showed common challenges specifically regarding medication prescribing situations, where challenges were perceived at least weekly in digital and verbal communication. Missing verbal communication regarding digital prescriptions given outside of regular physicians’ ward rounds was found to be a new central contributor to medication incidents. It is worth paying attention to this multiprofessional communication challenge in inpatient wards, to mitigate delays in prescribed medication, omissions of medication and unnecessarily prolonged medication periods. Other challenges perceived at least weekly were caused by non-communicable digital systems or their unskilled use. According to professionals, a common reason for missing digital prescriptions was unstandardised documentation, which supports previous research evidence. In order to enhance medication communication, health professionals suggested standardizing the prescribing process, medication documentation and medication reconciliations. They also suggested that the team taking care of medication care should be always notified verbally in case of digital prescribing outside of regular ward rounds. The professionals perceived that all digital medication care systems should be nationally communicable. They suggested that administrative communication about the importance of guideline compliance should be strengthened.

How can the results of your doctoral research be utilised in practice?

The results call attention to communication practices in multiprofessional teams when prescriptions are given outside of regular ward rounds. The suggestions by health professionals for enhancing medication related communication give an evidence base for managers to standardise documentation practices and to highlight the importance of guideline compliance, but also to encourage, guide, assess and secure guideline compliance in the unit. This is important, as in more than half of medication incident reports it was recognised that guidelines were bended or not followed. Noncompliance of guidelines was recognised more often than the fact that professionals did not know about the guidelines.

The analysis of medication incident reports showed that communication with a patient about his/her medication may reduce or stop medication incidents. Equally, transparent reporting of medication incidents, collegial feedback and mentoring seemed to prevent or stop medication incidents. According to the results, it looks like the fewer the communication challenges perceived, the higher was the incident reporting activity. An open safety culture means that it is safe to discuss mistakes and hazard situations, thus there is a possibility to learn as a team. The results gained with the tool show how important an open communication atmosphere is for incident reporting.

What are the key research methods and materials used in your doctoral research?

The study process started with a concept analysis of communication contributing to medication incidents, based on literature. The clinical relevance of the conceptual framework was tested by analyzing medication incident reports. Nearly all of indicator phrases of the framework were found in the reports. The framework was developed into a digital questionnaire with the help of a specialist panel. Health professionals were asked in a digital questionnaire how frequently they have experienced each communication challenge type during the last year in their responsibility area. Additionally, there were two open ended questions concerning the most common communication challenges and solutions for enhancing medication communication. Numeric results were analyzed using frequencies and percentages. Free text data was analyzed parallel by text mining and manual content analysis. By this way, the suitability of text mining method for questionnaire data analysis could be tested. The study is part of Associate Professor Marja Härkänen’s Medication administration safety and interventions (MASI) research project.

The doctoral dissertation of Tiina Syyrilä, MSc, RN, entitled Communication factors contributing to medication incidents in hospitals be examined at the Faculty of Health Sciences. The Opponent in the public examination will be Professor Marja Kaunonen of the University of Tampere, and the Custos will be Associate Professor Marja Härkänen of the University of Eastern Finland.

Doctoral defence (in Finnish)


For further information, please contact:

Tiina Syyrilä, tiina.syyrila(a),