(79) Improving Patient Safety: A Qualitative Study of The Implementation of the 'Know Check Ask' Medication Safety Campaign Among Healthcare Professionals, Patients and Carers

Publication Number: 410

Background: The Irish Health Service Executive (HSE) National Quality Improvement (NQI) team launched the ‘Know Check Ask’ (KCA) medication safety campaign nationally in 2019. The campaign encourages people/carers to take an active role in managing their medicines with 3 steps: (1) Know: your medicines and keep a list (2) Check: that you're using the right medicine the right way and (3) Ask: your health professional if you're unsure. Healthcare professionals (HCPs) are encouraged to engage with people about their medicines and the benefits of keeping lists.

Objectives: To (1) identify the barriers and facilitators to implementation of the KCA campaign among HCPs, patients and carers and (2) investigate attitudes to patient held medication lists (PHML)

Methods: Semi-structured telephone interviews were conducted with HCPs, people taking multiple medicines (5+ medicines concomitantly) and carers of people taking medicines; purposively sampled via social media, patient groups and research collaborators. Interviews were thematically analysed using the Framework method with the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF).

Results: Thirty-nine interviews were conducted with 9 patients, 9 carers and 21 HCPs (6 general practitioners; 2 hospital doctors; 7 community pharmacists; 2 hospital pharmacists and 4 nurses). All groups reported limited knowledge of the campaign as a result of disruption caused by the Covid 19 pandemic (e.g. electronic transfer/delivery of prescriptions). However patients, carers and HCPs expressed positive attitudes towards the campaign - seen as empowering for patients, with the potential to improve adherence. Most of the patients used lists and considered them useful in certain situations (e.g. during transitions of care) but concerns about the accuracy of PHML were expressed by all groups. Practical barriers reported across the groups included time pressures for HCPs and difficulties in maintaining medicine lists for patients on multiple medicines, with cognitive impairments or literacy issues. All groups reported the potentially positive influence of appropriate HCPs – such as pharmacists, GPs - in promoting the KCA as well as practical facilitators such as digital/compact lists.

Conclusions: The CFIR and TDF identified a number of barriers and facilitators to successful implementation at individual and organisational levels. Encouragement from key HCPs and development of a variety of list formats for patients/carers could significantly increase the impact of the KCA campaign. While attitudes to PHML are generally positive, concerns about the accuracy of lists - held in common by HCPs and patients/carers - need to be addressed.