Studied care phases and the geographical location of the studies

The reviewed articles were from six continents: Africa, Asia, Australia, Europe, North America, and South America. The studies represented 18 countries (Table 3), and studies from some countries were performed on more than one continent. Australian articles studied communication contributing to medication incidents in the admission and discharge phases, or all three phases (admission, inpatient, and discharge). In contrast, studies from the US studied inpatient and discharge phases and European studies primarily focused on the discharge phase.

Table 3. Countries represented among the reviewed papers published between 2010 and 2022 (n = 52) for each care process phase.

Care process

phase studied Study’s country

Number of countries

per care process phase

Number of studies per care

process phase

Admission Australia, Netherlands 2 2

Inpatient Australia (×8), the US (×6), the

Netherlands, Korea, Malaysia 5 17

Discharge

Australia (×4), Belgium, Canada, Denmark, Germany, Ghana, the Netherlands, Spain, Sweden, Switzerland, the UK, the US (×7)

14 21

Outpatient Norway, Sri Lanka 2 2

All phases (admission, inpatient, and

discharge)

Australia (×4), Brazil, Canada, Ireland, Malaysia, Netherlands,

Spain 7 10

Total 52

In the admission phase (Table 4), communication is insufficient about medication incidents causing hospital readmission (Lee et al., 2022). One patient may confront several medication errors, most of which are omissions (Chen et al., 2018).

In the inpatient phase (Table 4), 30%–70% of patients perceive

unsatisfactory communication regarding medication (Begum et al., 2020;

Bekker et al., 2020). Hierarchy and power relationships between professionals (Liu et al., 2013; Liu et al., 2016; Borrot et al., 2017) and between patients and health professionals (Liu et al., 2016) may contribute to medication communication. Insufficient medication communication during handover is described between nurses (Braaf et al., 2015) but also between health professionals and family members (Manias, 2015).

Communication gaps may compromise the implementation of medication prescriptions after physicians' ward rounds (Myers et al., 2017). Technical shortcomings contributing to communication may concern medication labelling (Huan-Keat et al., 2016), the ward’s physical structure, medication information retrieval devices (Liu et al., 2014), and EHRs (Tung et al., 2021).

Most of the 52 reviewed papers focused on the discharge phase (Table 3). Discharge is the most challenging phase in the care process, covering

>70% of prescription errors, whereas 10% of errors occur in the admission phase (Michaelson et al., 2017; Table 4). In the discharge phase,

communication challenges have been studied between the hospital and community (Foged et al., 2018), primary care (Uitvlugt et al., 2015), long- term nursing facilities (Kerstenetzky et al., 2018), and community pharmacies (Pellegrin et al., 2018). Communication challenges led to discrepancies in medication lists between the care facilities and delayed discharges due to omitted information (Moro Agud et al., 2016;

Kerstenetzky et al., 2018; Wilkin et al., 2018). The omitted information in hospital discharge summaries concerned amendments to medication and the reasons for changes during hospitalisation (Ehnbom et al., 2014; Shah et al., 2020; Uitvlugt et al., 2015; Wilkin et al., 2018). Multiple discrepant medication lists (Sarzynski et al.,2019) and noncommunicable digital systems (Glans et al., 2022) complicate the completion of discharge summaries.

Few studies have examined medication communication challenges during the outpatient phase (Table 4). Communication challenges may concern insufficient reporting of medication lists (Frydenberg et al., 2011) and language skills (Perera et al., 2012).

Studies covering admission, inpatient, and discharge phases (Table 4) described human-machine interactions, name confusion, and screen design problems contributing to half of the medication incidents (Cheung et al., 2014). Communication failures were between nurses, physicians, and pharmacists due to incomplete and inconsistent medication information in the clinical notes (Marques Cavalcante-Santos et al. 2021). Undocumented or unjustified medication amendments were communication challenges in 90% of patient records throughout the care process when legal

documenting requirements were investigated (Michaelson et al., 2017).

Older patients’ views on medication management communication during admission, hospitalisation, and transfer between settings have been rarely studied (Ozavci et al., 2021).

Table 4. Communication challenges identified in previous studies between 2010 and 2022 (n = 52)

Care process phase Communication challenges

in the previous 20 years Reference Admission

(n = 2)

Medication incident-related

readmissions Lee et al. (2022) Several medication incidents

per patient due to omissions Chen et al. (2018)

Inpatient (n = 17)

Patients’ perception of unsatisfactory medication

communication

Begum et al. (2020);

Bekker et al. (2020)

Uneven power relationships Liu et al. (2013); Liu et al.

(2016); Borrot et al.

(2017) Handover Braaf et al. (2015);

Manias (2015) Prescription implementation

post-ward-round Myers et al. (2017)

Technical shortcomings in labelling, ward structure,

devices, and EHRs

Huan-Keat et al. (2016);

Liu et al. (2014); Tung et al. (2021)

Discharge (n = 21)

Prescription errors Michaelson et al. (2017) Hospital-community Foged et al. (2018) Hospital-primary care Uitvlugt et al. (2015) Hospital-long-term nursing

facility Kerstenetzky et al. (2018) Hospital-community

pharmacies Pellegrin et al. (2018) Discrepancies in medication

lists between facilities that delayed discharge

Moro Agud et al. (2016);

Kerstenetzky et al.

(2018); Wilkin et al.

(2018) Missing information in

discharge summaries

Ehnbom et al. (2014);

Shah et al. (2020);

Uitvlugt et al. (2015);

Wilkin et al. (2018) Multiple medication lists Sarzynski et al. (2019) Noncommunicable digital

systems Glans et al. (2022) Outpatient

(n = 2)

Insufficient reporting about

medication lists Frydenberg et al. (2011) Language skills Perera et al. (2012) Admission,

inpatient, and discharge

(n = 10)

Human-machine interaction Cheung et al. (2014) Clinical notes between

nurses, physicians, and pharmacists

Marques Cavalcante- Santos et al. (2021) Unjustified amendments Michaelson et al. (2017) Communication

theory (n=2)

Concept of medication

communication Manias (2010) The Circle of Care Model

(CCM) Kitson et al. (2013)

2.4.2 Solutions to enhance medication communication in hospitals