Background: Medicine management in primary health care involves several participants: the prescribing physicians, various health care personnel involved in drug administration and patients with varying degrees of will and competence to be compliant. Many things can go wrong in this process, resulting in medication errors. This qualitative survey focuses on how information is transferred within primary healthcare and how prescription and administration of medicines are documented.
Material and methods: A random selection of GPs and medical secretaries in nine regular GP practices and a strategic selection of community nurses, personnel in nursing homes and emergency clinics and in hospital departments at the University Hospital of Northern Norway were interviewed in a semi-structured way during the spring of 2005. Observations were undertaken in both nursing homes and units for community nurses. Observations were logged, interviews taped, transcribed and the total material analysed.
Results: Necessary information on medication was not easily accessible to health care personnel in charge of patient care. Obtaining the information was time-consuming and the quality was variable and perceived as unreliable. Five out of nine GPs regarded a pharmacy prescription to be sufficient information to community nurses regarding alterations in patient medication. GPs seldom signed prescriptions in the nurses' medication chart. Patient medication information was not present when needed. Community nurses on night duty therefore often did not know what drugs they were handing out during their home visits. Discharge notes from the hospitals were often delayed, they were not sent to community nurses and just three out of nine GPs updated their medication summaries when receiving such information.
Interpretation: There is a need for improved communication and handling of information related to patient medication in primary health care. Patients in an ambulatory setting, who are not in charge of their own medication, are especially vulnerable to failure.