487 Understanding the Medicines Labelling System in a Tertiary Hospital in Kuwait Using Work Domain Analysis

Abstract Introduction A report by the World Health Organisation highlighted a lack of clarity in medicine labelling regulations in Kuwait and the subsequent risk of patient harm from labelling errors (1). In response, the Undersecretary of the Kuwait Ministry of Health (MOH) issued a ministerial decree governing the labelling of medicines (M.D 4451/2021, June 2021) (2), stipulating a requirement to affix an identification label containing specific patient, medicine, and supplier information on medication packaging. Aim To develop a map of the Medicines Labelling System (MLS) in a tertiary hospital in Kuwait (TH). Methods A Work Domain Analysis (WDA) was conducted using qualitative data from 1) semi-structured interviews with a purposive sample of 10 nurses, 10 patients/caregivers, and 10 pharmacists involved in the delivery or administration of medicines to TH patients, as well as 2) an analysis of medicine labelling documents published by the Kuwaiti MOH and TH. After gaining informed consent, one-to-one semi-structured interviews were conducted in TH, in accordance with the latest COVID-19 prevention procedures. All interviews were audio-recorded and transcribed verbatim. Both deductive – informed by Abstraction Hierarchy (AH), the modelling tool of WDA – and inductive thematic analysis was conducted. Results Thirty participants took part in semi-structured interviews averaging 34 minutes, from which five levels of abstraction in the AH were constructed. The first level, “functional purposes”, describes the reason why any given system exists: for the MLS in TH, they were “compliance with regulations, policies, and protocols of the Kuwaiti MOH and TH” and “providing an identification of medicine issued by ISH pharmacies”. Five aspects of the second level, “values and priority measures”, were identified, including “optimisation of service workflow” and “time-efficient clinical practices.” The third level, “purpose-related functions”, describes the key functions that need to be in place for the MLS to work; these were “the production of medicines labels”, “coordination”, and “management of medicines and resources”. The last two levels in the AH, “object-related functions” and “physical objects”, describe the resources that are required in the MLS, their functionality, and their limitations: there were 16 groups of physical objects, which afforded 19 different functions. Means-ends links showed the crucial relationships and significance between functions at