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Objectives: Previous studies on hospital discharge showed limited patient involvement, despite its positive outcomes. In this study, provider-patient communication used to enhance patient participation during discharge medication counselling was examined. Methods: This study comprises a qualitative descriptive observational study. Thirty-four discharge consultations were observed, audio recorded and analysed. We conducted a deductive analysis, elaborating on findings from earlier research. We selected themes and underlying codes illustrating professional-patient communication. For every theme, we identified examples to demonstrate its manifestation during discharge medication counselling. We also assessed what information healthcare professionals (HCPs) shared. Results: HCPs used cues to increase patient participation, e.g. inquired about patient's preferences, showed empathy and support, and verified understanding of information shared. Patient participation occurred through asking questions, and expressing concerns. A central component in discharge medication counselling was the transmission of information from HCPs to patients. This resulted in HCPs taking a leading role. Conclusions: Several HCP cues were detected inviting patients to participate in consultations. Some patients participated in discharge medication counselling. This was influenced by timing of discharge consults, the performing HCP and presence of a relative. Practice implications: HCPs shared a lot of information with patients. However, this does not automatically mean that patients will be able to understand and apply this information. HCPs should understand the importance of using cues to enable patient participation. One example is using the teach-back method for verifying patient understanding. It may also be desirable to ensure that a relative is present when discharge information is offered.

Objectives: Performing medication reconciliation (MR) is an important safety initiative. However, its implementation is complex. We used the Functional Resonance Analysis Method (FRAM) to gain more understanding of healthcare professionals’ low compliance with the standards for MR by comparing Dutch guidelines and hospital protocols (Work-as-Imagined/WAI) with daily clinical practice (Work-as-Done/WAD). Methods: Nine cardiology and orthopaedics wards participated in this study. We applied the FRAM to construct several models to visualise MR at the point of discharge. WAI models were based on national guidelines and hospital protocols. Data to construct the WAD models were collected through semi-structured interviews with the healthcare professionals involved. Results: Sixty-three healthcare professionals were interviewed. These occasionally had to adjust their work in order to manage a lack of time or resources, resulting in variation in healthcare professionals’ performance. This had an impact upon the flow of the reconciliation process due to the interdependency of all the healthcare professionals involved. Conclusion: Collaboration between healthcare professionals is essential to ensure complete reconciliation for discharged patients. We identified a distinction between daily practice and both the guidelines and protocols followed. Future research should indicate the impact of specific variations in practice, and deviations from the protocols on medication safety, during reconciliation.

Background Understanding consumers’ interpretation of allergy information is crucial for effective food safety policies. We evaluated consumer understanding of allergy information on foods in controlled, experimental studies. Method Using 18 packaged foods, we evaluated consumer understanding of information about allergens in two experiments: First, a comparison of foods with no stated allergen versus allergen as a stated ingredient versus a precautionary allergen label (PAL); second, a comparison of three common variants of PAL. In each experiment, consumers with and without self‐reported food allergy were asked to estimate the risk of allergic reaction and to rate the comprehensibility of the allergen information. In the second experiment, consumers were also asked which form of PAL they preferred. Results Risk of reaction was assessed as high and low for foods with the allergen stated as ingredient, or without any mention of allergen. However, risk assessment for PAL varied and was judged as higher by non‐allergic than allergic participants (82% vs. 58%, p, Food labels are a crucial source of information for allergic consumers, but despite ingredient declaration legislation, allergic reactions frequently occur. We evaluated common allergy information on foods in two controlled experimental studies. Allergic consumers attribute lower risks to products with PAL than consumers without FA, different risks are attributed to different PAL wordings especially by consumers with higher levels of Health Literacy, and less than 50% of participants judge allergy information to be clear. Better allergy information is called for.

Background Healthcare professionals are sometimes forced to adjust their work to varying conditions leading to discrepancies between hospital protocols and daily practice. We will examine the discrepancies between protocols, ‘Work As Imagined’ (WAI), and daily practice ‘Work As Done’ (WAD) to determine whether these adjustments are deliberate or accidental. The discrepancies between WAI and WAD can be visualised using the Functional Resonance Analysis Method (FRAM). FRAM will be applied to three patient safety themes: risk screening of the frail older patients; the administration of high-risk medication; and performing medication reconciliation at discharge. Methods A stepped wedge design will be used to collect data over 16 months. The FRAM intervention consists of constructing WAI and WAD models by analysing hospital protocols and interviewing healthcare professionals, and a meeting with healthcare professionals in each ward to discuss the discrepancies between WAI and WAD. Safety indicators will be collected to monitor compliance rates. Additionally, the potential differences in resilience levels among nurses before and after the FRAM intervention will be measured using the Employee Resilience Scale (EmpRes) questionnaire. Lastly, we will monitor whether gaining insight into differences between WAI and WAD has led to behavioural and organisational change. Discussion This article will assess whether using FRAM to reveal possible discrepancies between hospital protocols (WAI) and daily practice (WAD) will improve compliance with safety indicators and employee resilience, and whether these insights will lead to behavioural and organisational change. Trial registration Netherlands Trial Register NL8778; https://www.trialregister.nl/trial/8778. Registered 16 July 2020. Retrospectively registered.