005 pp: the benefits of using qualitative research methods to understand care home medicine management systems.

In United Kingdom care homes (CHs), multi-compartment compliance aid (MCA) medicine management systems are more commonly used than original medicine packaging (OP), to organise and administer the large volume of medicines used by residents. This study aimed to understand how these two systems (MCAs and OP) impact on CH medicine administration. This was a mixed methods study. The quantitative component involved direct observation to identify discrepancies in medicine administration. The qualitative component involved an ethnographic approach and interviews to understand the medicine administration process and identify associated barriers/facilitators. In September and October 2014, a pharmacist researcher spent 1-3 days observing 17 nurses administer medicines and interviewing 15 nurses, at 4 purposively sampled CHs around Greater London that used either MCAs or OP. Ethical approval was obtained from the University College London Research Ethics Committee. The ethnographic approach allowed the researcher to immerse themselves into the work environment of the nurses. This facilitated a comprehensive understanding of the MCA and OP medicine management systems under research, at all times of the day and under all possible work conditions that could arise. The observations allowed the researcher to identify practices that may contribute to medicine administration discrepancies. These practices may not have been discussed at all, or in any great detail, during nurse interviews. Potential challenges of this qualitative research include participant apprehensiveness concerning the observations in general, or observations interfering with daily work practices. These were managed by ensuring observations were minimally intrusive and all participating CHs and nurses remained anonymous. The qualitative research methods used in this study helped explain the quantitative data and provided a rich and comprehensive understanding of the systems under research, which is unlikely to have occurred using quantitative research methods alone