{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:58:37Z","timestamp":1790186317382,"version":"4.1.0"},"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T00:00:00Z","timestamp":1667433600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Greater Manchester Mental Health Trust","award":["RCF14GH2"],"award-info":[{"award-number":["RCF14GH2"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Research suggests that patients who are prisoners experience greater morbidity, increased health inequalities and frequent preventable harm, compared to the general population. Little is known about the process and influencing factors for safe prescribing in the unique prison environment, which may limit the development efforts to improve the quality of care in prisons. This study aimed to understand the process and challenges associated with prescribing in prisons, explore the causes and impact of these challenges, and explore approaches to improve prescribing safety in prisons.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Grounded theory informed data collection and analysis of a nominal group discussion by seven participants and semi-structured telephone interviews with twenty prison healthcare staff, including GPs, pharmacists, psychiatrists and nurses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Findings<\/jats:title>\n<jats:p>The underlying complexity of prescribing in prison settings increased the level of challenge and influenced the safety of this process. Multiple contributors to the challenges of safe prescribing were identified (comprising governance and policy; the prison structure; staff retention, training and skill mix; IT systems and interface; polypharmacy and co-morbidity; tradability and patient behaviour) with overarching constructs of variations in practice\/policy and the influence of prison culture. Participants identified measures to address these challenges through multi-disciplinary collaborative working, increased consistency in processes, and the need for more innovation and education\/training.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our study highlighted that healthcare provision in prisons is unique and needs to tailor the care provided to patients without enforcing a model focused on primary, secondary or tertiary care. Participants emphasised a necessary shift in workplace culture and behaviour change to support improvements. The COM-B model of behaviour change may be effectively applied to develop interventions in organisations that have in-depth understanding of their own unique challenges.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0275907","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T17:50:59Z","timestamp":1667497859000},"page":"e0275907","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":19,"title":["Exploring the challenges to safer prescribing and medication monitoring in prisons: A qualitative study with health care staff"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0584-2798","authenticated-orcid":true,"given":"Esnath","family":"Magola-Makina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aseel S.","family":"Abuzour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren M.","family":"Ashcroft","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Dunlop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard N.","family":"Keers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,11,3]]},"reference":[{"issue":"1","key":"pone.0275907.ref001","doi-asserted-by":"crossref","first-page":"6488","DOI":"10.1038\/s41598-021-85916-w","article-title":"Characteristics and comparative clinical outcomes of prisoner versus non-prisoner populations hospitalized with COVID-19","volume":"11","author":"A. 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Breaking point: Understaffing and overcrowding in prisons\u2014Research briefing."},{"issue":"2","key":"pone.0275907.ref016","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1177\/0951484818787698","article-title":"Finding meaningful work in difficult circumstances: A study of prison healthcare workers","volume":"32","author":"A. L. Stephenson","year":"2019","journal-title":"Health services management research: an official journal of the Association of University Programs in Health Administration"},{"issue":"11","key":"pone.0275907.ref017","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.2105\/AJPH.2009.184242","article-title":"Patient safety: moving the bar in prison health care standards","volume":"100","author":"M. F. Stern","year":"2010","journal-title":"Am J Public Health"},{"key":"pone.0275907.ref018","unstructured":"World Health Organization. \u201cThe third WHO Global Patient Safety Challenge: Medication Without Harm.\u201d Retrieved 20 August, 2020, from https:\/\/www.who.int\/patientsafety\/medication-safety\/en\/."},{"issue":"7","key":"pone.0275907.ref019","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1007\/s40264-015-0304-x","article-title":"Primary Care Medication Safety Surveillance with Integrated Primary and Secondary Care Electronic Health Records: A Cross-Sectional Study","volume":"38","author":"A. Akbarov","year":"2015","journal-title":"Drug Safety"},{"key":"pone.0275907.ref020","article-title":"Frequency and Nature of Medication Errors and Adverse Drug Events in Mental Health Hospitals:a Systematic Review","author":"G. H. Alshehri","year":"2017"},{"key":"pone.0275907.ref021","article-title":"A Patient Safety Toolkit for Family Practices","author":"M. S. Campbell","year":"2018","journal-title":"Journal of Patient Safety"},{"issue":"9823","key":"pone.0275907.ref022","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1016\/S0140-6736(11)61817-5","article-title":"A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis","volume":"379","author":"A. J. Avery","year":"2012","journal-title":"The Lancet"},{"issue":"5","key":"pone.0275907.ref023","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1111\/bcp.12087","article-title":"Developing consensus on hospital prescribing indicators of potential harms amenable to decision support","volume":"76","author":"S. K. Thomas","year":"2013","journal-title":"British journal of clinical pharmacology"},{"issue":"3","key":"pone.0275907.ref024","doi-asserted-by":"crossref","first-page":"183","DOI":"10.14236\/jhi.v25i3.1015","article-title":"SMASH! The Salford medication safety dashboard","volume":"25","author":"R. Williams","year":"2018","journal-title":"BMJ Health & Care Informatics"},{"key":"pone.0275907.ref025","doi-asserted-by":"crossref","first-page":"l4185","DOI":"10.1136\/bmj.l4185","article-title":"Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis","volume":"366","author":"M. Panagioti","year":"2019","journal-title":"BMJ"},{"issue":"1","key":"pone.0275907.ref026","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1186\/s12916-020-01774-9","article-title":"Preventable medication harm across health care settings: a systematic review and meta-analysis","volume":"18","author":"A. 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Bowen","year":"2009","journal-title":"International Journal of Mental Health Systems"},{"issue":"3","key":"pone.0275907.ref029","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1111\/jsr.12503","article-title":"Insomnia management in prisons in England and Wales: a mixed-methods study","volume":"26","author":"L. H. Dewa","year":"2017","journal-title":"Journal of Sleep Research"},{"key":"pone.0275907.ref030","unstructured":"Royal Pharmaceutical Society (2017). Professional standards for optimising medicines for people in secure environments: Prisons, young offender institutions and secure training centres."},{"key":"pone.0275907.ref031","unstructured":"National Institute for Health and Care Excellence (2017). \u201cPhysical health of people in prisons.\u201d Retrieved 8 October, 2020, from https:\/\/www.nice.org.uk\/guidance\/qs156."},{"key":"pone.0275907.ref032","unstructured":"Royal College of Nursing. \u201cMedicines Management.\u201d Retrieved 12.04.2022, 2022, from https:\/\/www.rcn.org.uk\/clinical-topics\/medicines-management#:~:text=So%20what%20is%20medicines%20management,same%20time%20minimising%20potential%20harm.%E2%80%9D."},{"issue":"10","key":"pone.0275907.ref033","doi-asserted-by":"crossref","first-page":"e0206233","DOI":"10.1371\/journal.pone.0206233","article-title":"What causes medication administration errors in a mental health hospital? A qualitative study with nursing staff","volume":"13","author":"R. N. 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