Understanding the implementation of a multidisciplinary intervention using a suite of prescribing safety indicators to improve medication safety in prison healthcare settings: a qualitative study.

Abstract

Patients residing in prisons are a vulnerable group with more complex health needs and higher prevalence of inappropriate prescribing than the general population. Overcrowding in prisons, inadequate staffing levels, diversion of medication and substance misuse present challenges to prison healthcare. Interventions that use prescribing safety indicators are one way of helping to reduce the risk of harm by identifying patients at risk of potentially hazardous prescribing. This qualitative study aimed to understand the implementation and impact of a suite of seven prescribing safety indicators, specifically developed for use in prison settings, as part of a multi-disciplinary intervention. Semistructured interviews were conducted with a range of prison healthcare staff across 30 different prison sites in England. In addition, an online survey was made available to all healthcare staff in participating prisons. Data analysis of interview transcripts and free-text survey responses was conducted following a thematic approach and informed by normalisation process theory. Interviews were conducted with 9 prison healthcare staff and 40 completed the survey, with 18 staff providing free-text responses. Three themes were interpreted from the data: bringing people together and establishing individual and collective roles that facilitated implementation of the intervention; developing new tasks, work processes and practices to make the intervention work in everyday practice; and seeing the benefits and value of the intervention and new work processes within the context of prison healthcare provision. New work processes and practices were instigated in order to implement the intervention, often fitting into existing medication safety practices, building on other prescribing work and creating learning across the team. While we found that prison staff reported challenges to implementation, similar interventions may be used for prescribing safety in prison settings.