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Prescribing in acute healthcare settings is a complex interprofessional process with a high incidence of medication errors. Opportunities exist to improve prescribing learning through collaborative practice. This qualitative interview-based study aimed to investigate the development of junior doctors' prescribing capacity and how pharmacists contribute interprofessionally to this development and the prescribing practices of a medical community. The setting for this study was a large teaching hospital in Australia where ethical approval was gained before commencing the study. A constructionist approach was adopted and the interviews were held with a purposive sample of 34 participants including junior doctors (n = 11), clinical supervisors (medical; n = 10), and pharmacists (n = 13). Informed by workplace learning theory, interview data were thematically analysed. Three key themes related to pharmacists' contributions to prescribing practices emerged: building prescribing capacities of junior doctors through guidance and instruction; sustaining safe prescribing practices of the community in response to junior doctor rotations; and transforming prescribing practices of the community through workplace learning facilitation and team integration. These findings emphasize the important contributions made by pharmacists to building junior doctors' prescribing capacities that also assist in transforming the practices of that community. These findings suggest that rather than developing more conventional education programs for prescribing, further consideration should be given to interprofessional collaboration in everyday activities and interactions as a means to promote both effective learning for individuals and advancing the enactment of effective prescribing practice.

Rationale, aims, and objectives Medication discrepancies place patients discharged from hospital at risk of adverse medication events. Patient and family participation in medication communication may improve medication safety. This study aimed to examine older medical patient and family participation in discharge medication communication. Methods Two‐phased mixed‐methods study. Data were collected from July 2018 to May 2019. Phase 1 comprised observations and a questionnaire of 30 patients pre‐hospital discharge. Phase 2 involved telephone interviews with 11 patients and family members post‐hospital discharge. Phase 1 analysis included descriptive statistics and deductive content analysis. Inductive content analysis was used in Phase 2. Phase 1 and 2 findings were integrated. Results For Phase 1, observational data were deductively coded against the “continuum of patient participation”; information‐giving was the most frequent level of participation observed on the continuum, followed by information‐seeking, shared decision making, non‐involved, and finally autonomous decision making. For descriptive statistics, written communication tools, noise, and interruptions were frequently observed during medication communication. In Phase 2, three categories were found about how patients and families participate, and the factors influencing their participation: (a) obtaining comprehensive medication information; (b) preferred approaches for receiving information; and (c) speaking about medications in hospital. Integrated findings showed that written communication tools and routine hospital tasks may promote, while lack of family presence and environmental factors may hinder medication communication. Patients' and families' role in medication communication ranged from asking questions to influencing decisions, and was enhanced by health care professionals' patient‐centred communication. Conclusions More active patient and family participation could be achieved by encouraging them to identify medication‐related problems. To create a climate for patient and family participation, health care professionals should use written communication tools, capitalize on participation opportunities during routine hospital tasks, and use patient‐centred communication.

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BACKGROUNDAnticoagulation reduces stroke risk in patients with atrial fibrillation (AF) but underprescribing in eligible patients has been commonly reported. Introduction of the direct acting oral anticoagulants (DOACs) was considered to potentially improve prescribing due to increased anticoagulant options. At the time of release to the Australian market, there was limited studies investigating anticoagulant usage during hospitalisations for AF. Therefore, the aim of this study was to investigate prescribing of oral anticoagulants during hospitalisations admissions for AF during the time of DOAC introduction to the Australian market. METHODA retrospective study was conducted of admissions to a tertiary Queensland hospital during 1 July 2012 to 10 June 2015. Patients were categorised according to oral anticoagulant therapy on both hospital admission and discharge. Changes to therapy and patient factors associated with prescribing were analysed. RESULTSA total of 1911 patients were included with 3396 admissions during the study period. There was a significant increase in the number of patients initiated on anticoagulant therapy during their first admission with higher rates of initiation of DOACs compared to warfarin.Ischaemic heart disease and high bleed risk were significantly associated with reduced prescribing of anticoagulant therapy on first and second admission respectively, while patients with history of stroke or transient ischaemic attack were significantly more likely to receive therapy. CONCLUSIONThe introduction of the DOACs to the Australian market increased initiation of anticoagulants to hospitalised patients with AF across all stroke risk categories. The availability of greater anticoagulant options has increased initiation of therapy but there remains potential to further optimise anticoagulant prescribing by targeting therapy according to guidelines and patient factors.