Surgical nurses' perceptions and experiences of a medications and oral restrictions policy change: a focus group study.

Abstract

To explore the perceptions and experiences of surgical nurses before and after introducing the Medications and Oral Restrictions Policy (the Policy). The Policy was developed following extensive consultation, and evidence-based strategies were considered for its implementation. However, it is possible uptake did not meet expectations. Focus group interviews. Three focus groups were conducted in November 2015 around 'what worked, what didn't and why, before and after hospital-wide implementation of the Policy. Data were coded and analysed using an inductive-deductive Thematic Analysis approach. The COREQ checklist guided reporting (see Supplementary File). The three groups consisted of 16, 14 and six surgical nurses. Before the Policy there was confusion, lack of clarity and guidance, and lack of experience and confidence in managing medications when patients had oral restrictions. After the Policy rollout there was a sense of 'knowing what to do' because of improved clarity and decision support; but there were also problems with: not everyone knowing about the policy, particularly due to staff movement and turnover; and, individual interpretation of the policy including use of its signs outside of context, and decision-making processes. Exploration of nurses' perceptions of a medication-related policy change found that while the Policy provided clarity and decision support for some it made little difference for others. Limited reach of the policy was an issue despite an effort to address this at the outset, as well as variations in interpretation of the policy and subsequent decision making. How individuals interpret information and their understanding of the context behind the policy or guideline may affect implementation and should be considered alongside other barriers when implementing medication-related initiatives. Furthermore, implementation strategies that are independent of ongoing resources and/or key champions to sustain should be prioritised for all initiatives. This article is protected by copyright. All rights reserved.