Qualitative insights into patients and family members’ experiences of in-hospital medicines management after a critical care episode

Background Patient recovery after a critical illness can be protracted, requiring a care continuum that extends along a patient pathway from the critical care unit, hospital ward and into the community care setting. High-quality care on patient transfer from critical care, including medication safety, is facilitated by education for patients and families, family engagement, support systems and healthcare professional-patient communication. Currently, there is uncertainty on how healthcare professionals can and should engage with critical care patients and family members about their medication. Research Question We aimed to explore the views and experiences of critical care patients and family members about their involvement, communication, understanding, and decision making related to their medication following transfer from critical care to the hospital ward. Study Design and Methods Qualitative study, using semi-structured interviews, conducted with critical care patients and family members after transfer from critical care to a hospital ward in a large National Health Service hospital Trust. Anonymized transcripts of interviews were thematically analysed using a coding framework developed from understandings of patient and family engagement in their medication. Results Twenty-seven participants (15 patients and 12 family members of patients) completed the interviews. We identified five themes and 15 sub-themes, providing an overview of patients and family members’ views on their medication management during their acute illness and ongoing recovery. Themes identified were: Impact of acute illness and treatment burden on pre-existing illness; Pre-existing knowledge and capability; Beliefs about persons roles and expectations; Care continuity and individualised information exchange; and Engagement in practice. Interpretation Critical care patients and family members want to engage with healthcare professionals about their medication. Health care professionals must take an individualized approach to communication and timing, acknowledging the dynamic interplay between patients and family members, using multimodal forms of communication.