Navigating safety in practice: a qualitative study of how health care personnel organize medication management in Norwegian home care services.

backgroundMedication management for older adults receiving municipal home care services involves daily coordination between home care staff, general practitioners, pharmacies, and hospitals across frequent care transitions and regulatory requirements. Although regulations, guidelines, and safety approaches are intended to support safe medication practices, healthcare professionals (HCPs) in home care work under conditions marked by time pressure, limited resources, and frequently changing medication information. However, there is limited knowledge about how HCPs interpret and apply these regulatory frameworks in everyday home care practice. This study aims to explore how HCPs organize medication management to ensure patient safety in Norwegian home care services.

methodsA focused ethnographic design was employed in three purposively sampled Norwegian municipalities. Data were generated through 218 h of participant observation, informal interviews, photographs, and document collection involving 25 participants from various professional backgrounds. The data were analyzed via an iterative ethnographic method inspired by Roper and Shapira.

resultsThe findings revealed an overarching cultural orientation, "the here and now," along with two interconnected pattern categories: "performing resilience: making the day run" and "enacting system integration: chasing the right information." Medication management was organized through continual coordination, task prioritization, and repeated efforts to obtain and verify medication information. Although HCPs adhered to regulations and guidelines, written procedures were inconsistently referenced in daily work. Instead, medication safety relies on locally organized practices, shared understandings, and adaptation to immediate demands.

conclusionMedication safety in municipal home care is maintained through a continuous, interpretive process shaped by the practical realities of daily work. Regulations and guidelines function alongside locally organized coordination and information work rather than as linear instructions. Understanding medication management as it unfolds in the here and now provides insight into the gap between work-as-imagined and work-as-done. This study contributes to the analytical concept of "here and now" to explain how medication safety is enacted through real-time coordination and information work in municipal home care. These findings indicate that guidelines and digital systems require improvement to better support real-time coordination and information work, and safety interventions also need to address local sensemaking and cross-organizational communication.