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).