Table 2 Summary of healthcare professionals’ experiences of medication evaluation (number of critical incidents = 445)

Sometimes it is the healthcare centre and sometimes it is the hospital that manage different things. // And then he has some skin problems as well, and is connected to Dermatology as well. // Then it becomes very difficult for them to see kind of a whole. [Person13]

Collaboration between colleagues (14 + 25 = 39)

Co-operation around the older person (117)

Working in partnership (222)

You know, she [the patient] has so many contacts with health services overall, so I kind of end up in between all these contacts, you could say. [Person10]

Nurse as a coherent link (14 + 18 = 32)

The wife was very careful at home as well. She weighed her hubby every day and // and then [performed] liquid measurement as well. She kept track of how much he drank each day and so on. [Person5]

Formal or informal caregiver as an intermediary (8 + 22 = 30)

It is one call away, you can have a dialogue directly and then you can change the medication quite quickly // so that the patient gets help, with pain relief for example then. [Person14]

Forum for interaction (0 + 9 = 9)

And then this information is to be filtered then // through me, that is // yes, right, to evaluate the treatment when the patient cannot speak for themselves. [Person17]

Difficult to evaluate through others (4 + 3 = 7)

Who has no, so to speak, home healthcare contact. And she has not wanted to receive homecare. [Person23]

Older persons’ autonomy (10 + 22 = 32)

The older person as a partner (105)

He didn’t understand that he was meant to go and re-fill it; instead, he thought it was a limited treatment period. [Person9]

Older persons’ ability to understand (6 + 23 = 29)

It is difficult to evaluate these blood pressure medications in her case as well. Because we don’t really know what she is taking or if she is taking anything at all. [Person6]

Older persons’ adherence to therapy (5 + 16 = 21)

Even if the patient is cognitively lucid, it is not so easy if you write and that becomes only sentences for them… [Person8]

Older persons’ need of understandable information (7 + 7 = 14)

I cannot keep calling all the time either like that, you know. // But she was cognitively capable of contacting us if needed // and I trust that. So, then I feel, that then it will have to be the patient’s responsibility to get in touch. [Person26]

Expectations on older persons (3 + 6 = 9)

I observe that the patient has had a very hard time with breathing, it is heavy breathing and one sees it very clearly. It becomes evident when it is time to evaluate the effect of diuretics, for example as in this case. [Person18]

Practical application of knowledge (16 + 13 = 29)

Clinical knowledge and experience (72)

Working conditions (223)

Anyway, she got the best triple treatment recommended today // She was meant to have that, but she, if you had only looked at her, kind of, then you understand that she, she is an old and frail person. [Person25]

Knowledge about medications for older persons (10 + 5 = 15)

And then it is difficult to evaluate when someone has been taking something [a medication] for a long time then. No, but that’s my theory, I don’t know. [Person19]

Complexity in medication evaluation (13 + 1 = 14)

It is a bit difficult to know cognitively how, how aware this patient was on the whole. Because he sounds very ‘with it’, but he probably is not, we have realized. [Person2]

Difficult to assess self-care in older persons (5 + 8 = 14)

Then afterwards she actually reported a [blood] pressure that was okay. So, I think I had followed it up, and that we kind of accepted it. Because she had around 140 anyway at the healthcare centre. [Person24]

Frequency decrease over time (16 + 18 = 34)

Situational conditions (151)

Then it’s pulse, saturation, and blood pressure primarily. Leg swelling and the patient’s sense of well-being // and symptoms of hallucinations, psychological symptoms. That’s what I wanted, to get updated on. [Person21]

Facilitate by using a plan (16 + 22 = 32)

It is a lot of medications and often he can show up every now and again for other small issues, that he has a sore foot or some other small thing. And then you never have enough time to go through everything. [Person24]

Resource to perform in a good way (15 + 14 = 29)

And what is important, as I see it, is I guess that you do not just carry on…like, renew prescriptions and so on. And then you… yes, then you kind of have to think twice and it is rarely such an emergency, that all pills are finished. [Person28]

Medication management trigger (8 + 14 = 22)

So she gives feedback to me in the same way, through electronic messaging and… sometimes we also speak on the phone of course. But… it is a smooth way to communicate quickly so you don’t need to disturb them in their work. [Person27]

Written communication to colleagues (4 + 10 = 14)

‘That the patient is discharged from here. She has completed her treatment here. We refer this on to the healthcare centre’ and I don’t know what their routines are. Why or where that request for follow-up goes… no? [Person14]

Familiarity with the work of others (2 + 10 = 12)

I received feedback from the hospital where the patient was admitted due to dehydration, then we realized that this was such a high dose of diuretics after the previous interaction. [Person20]

Adverse event due to absence of evaluation (4 + 4 = 8)