3.6 Competing pressures and priorities
The narrative of doctors illustrated that prescribing behaviour is
contextualised by the environment within which they work. For example,
owing to the limited number of doctors and reduced availability of
pharmacists when working out of hours, a process of prioritisation arose
by necessity.
“If it’s 2’oclock in the morning…if you have other things
going on, then you would prescribe the stuff that needs to be done and
then highlight [other prescribing] to the day team”.
(Doctor, 2016)Sometimes, high workload levels mitigate against doctors responding to
system alerts designed to flag up medication warnings which may be
over-ridden during busy times.
“… because you’re doing a busy ward round [and a pop-up
message arrives] you just press okay, okay. It’s the automatic
alerts that come up…. For pretty much everything and sometimes
you say ‘okay, carry on’ [and] every click takes just 10
seconds” (Doctor, 2016).
One doctor recalled that he had been requested to expedite preparation
of a ‘take home’ prescription for a patient – “… the
review of the medications as a whole comes when the patient is in the
discharge lounge and the nurses are on your neck – ‘Do the TTO! Do the
TTO! Do the TTO! So, you don’t actually have time to review ” (Doctor
2017).