DIMENSION SUBTHEME
Patient characteristics 1,2 Presenting complaint or pathology
Age of patient
Wishes of family
Adherence
Drug characteristics 1,2 Clinical picture informing prescribing decisions
Avoiding harm
Polypharmacy
Drawing upon guidelines as resource (e.g. NICE)
Iatrogenesis
Review / lack of review of medication
Pharmacist factors 1,2 Pharmacist as checker and optimiser, not clinical decision maker
Expertise
Trustworthiness 1,2 Distrust of information source until proved correct / reconciled
Doctors compared with pharmacists and vice-versa
Perception that junior doctors may not have enough experience to review drugs
Marketing effects 2 Not overtly observed in verbatim transcripts
Reliability of medication history (written and verbal) 1
Confidence in obtaining accurate history Filling in knowledge gaps from collateral sources Availability & functionality of Electronic Prescribing & Administration System / use of decision support tools Language ambiguity
External pressures & priorities1 Time-consuming aspects of job
Pressure to expedite ‘take home’ prescription on discharge
Coping strategies in response to demands on workload
Responsibilities of prescribers1 Reluctance to change medicines perceived not to be associated with cause of admission
Passing the buck. Perception that GP (not self) is responsible for prescribing drugs that were originated in primary care setting