The role of organizational and professional cultures in medication safety: a scoping review of the literature

Abstract

Purpose This scoping review explores what is known about the role of organizational and professional cultures in medication safety. The aim is to increase our understanding of ‘cultures’ within medication safety and provide an evidence base to shape governance arrangements. Data sources Databases searched are ASSIA, CINAHL, EMBASE, HMIC, IPA, MEDLINE, PsycINFO and SCOPUS. Study selection Inclusion criteria were original research and grey literature articles written in English and reporting the role of culture in medication safety on either organizational or professional levels, with a focus on nursing, medical and pharmacy professions. Articles were excluded if they did not conceptualize what was meant by ‘culture’ or its impact was not discussed. Data extraction Data were extracted for the following characteristics: author(s), title, location, methods, medication safety focus, professional group and role of culture in medication safety. Results of data synthesis A total of 1272 citations were reviewed, of which, 42 full-text articles were included in the synthesis. Four key themes were identified which influenced medication safety: professional identity, fear of litigation and punishment, hierarchy and pressure to conform to established culture. At times, the term ‘culture’ was used in a non-specific and arbitrary way, for example, as a metaphor for improving medication safety, but with little focus on what this meant in practice. Conclusions Organizational and professional cultures influence aspects of medication safety. Understanding the role these cultures play can help shape both local governance arrangements and the development of interventions which take into account the impact of these aspects of culture.

‘Stolen Time’- Delivering Nursing at The Bottom of A Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing For Patients With Community Acquired Pneumonia.

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Barriers and facilitators of medicines reconciliation at transitions of care in Ireland – a qualitative study

“…prescribing pharmacists) in the prescribing process is increasingly common and shown to be effective [27]. However, coupled with this, is the need to have functioning multidisciplinary teamsthrough openness to the opinion of others and willingness to compromise [12,28].…”

Predictors of antibiotic prescriptions: a knowledge, attitude and practice survey among physicians in tertiary hospitals in Nigeria

“…Organization culture may also in uence how physicians prescribe. [59] Studies suggest that "prescribing etiquette" are usually created by senior physicians and passed on to junior physicians as part of mentorship process and to maintain the 'culture' of prescription within clinical groups. [46,60,61] Recognizing the importance of institutional context and peculiarities in the implementation of ASP, the WHO recommends institutional situational analysis and needs assessment before implementation of AMS in healthcare settings.…”