Medication safety in action:transcending facts and figures through health professionals’ everyday working practices

Medication safety is often understood, studied and discussed in terms of medication errors (ME) and adverse drug events (ADE). However, we argue, a more comprehensive look at the processes and practices involved in the medication process might not only shed light on why and how ME and ADE happen, but also enable new pathways to address and manage medication safety in health care organisations.This is particularly important given the rapid growth of technologies that are expected to improve medication safety, such as ePrescribing, the implementation and impact of which could be better understood in the context of a greater understanding of previously existing practices.We draw on two closely related qualitative datasets, both from a paediatric secondary and tertiary hospital in England: (i) a qualitative case study in a surgical ward, exploring the role of nurses in the medication process (prior to the implementation of ePrescribing), using focus groups and interviews; and (ii) the ‘before’ stage of a longitudinal ethnographic study, exploring the effects of implementing ePrescribing on in-patient care provision.Across these two datasets we explore what practices are involved in the medication process from health professionals’ perspectives, and how these are enacted in the context of their everyday working practices to ensure safety. Our findings suggest that medication safety is a collective practice accomplished through a dynamic set of interactions, practices and situations through which medication risks are managed – often beyond the boundaries of key organisational elements such as roles, formal knowledge or reporting systems