Pharmacists, nurses, and physicians’ perspectives and use of formal and informal interpreters during medication management in the inpatient setting
Introduction
Approximately 8.6% of the population in the U.S., or 25 million people, have Limited English Proficiency (LEP), defined as speaking English less than “very well” [1]. Individuals with LEP are more likely to lack health insurance, live below the poverty line, have lower health literacy, and have less than a high school education compared to those with English proficiency [2]. Individuals with LEP may experience significant communication barriers with healthcare professionals which can result in adverse outcomes [3], [4]. Communication errors can occur when healthcare providers use informal interpreters such as family members or non-qualified staff [5]. Use of trained, formal interpreters is associated with improved quality of care and patient satisfaction [6]. Yet due to a variety of barriers, including lack of perceived need, time, and availability, medical professionals may not always use formal interpreters [7], [8]. A 2019 study found that fewer than 60% of patients with LEP reported that their medical provider always explained things in a way they could understand [9]. As a result, patients with LEP are more likely to have serious adverse events during hospitalization, have a longer length of stay in the hospital, and have a higher risk of 30-day hospital readmissions compared to non-LEP patients [10], [11], [12], [13].
Language barriers in medication management can occur during medication reconciliation on admission or discharge and during inpatient medication administration, leading to serious safety and quality concerns [5], [14], [15], [16], [17]. One study in a Dutch hospital found that nurses sometimes skipped safety protocols regarding double-checking names and birth dates prior to administering medications in patients with language barriers [15]. Nurses also had a difficult time measuring pain levels in patients with language barriers, opting for visual inspections or skipping pain assessments. These practices could lead to a systematic undertreatment of pain among patients with language barriers [18]. Moreover, medications often change significantly during and after hospitalization, requiring important communication exchanges with patients and caregivers [14], [16]. This important information exchange can be significantly hampered in the presence of language barriers. In a study of 308 Spanish-, Chinese- and English-speaking patients across two hospitals, researchers found that LEP patients were less likely to understand discharge instructions, including the category or purpose of discharge medications [14].
While some studies have examined perceptions and experiences with language barriers in the inpatient setting, few have examined clinicians’ experiences with language barriers specifically around medication management in the hospital. Moreover, few studies have examined inpatient pharmacists’ experiences with language barriers. This study is part of a larger study examining intrahospital medication management and post-discharge patient counseling [19]. The objective of this specific study was to describe clinicians’ perspectives about linguistic and cultural barriers to providing medication management, education, and counseling to LEP patient and caregivers.
Section snippets
Setting
The study was conducted among pharmacist technicians, pharmacists, nurses, and physicians working in a tertiary care hospital in Southern California. California has one of the highest proportions of LEP residents in the U.S. Nearly 24% of Californians – 1 in 4 – are LEP [20], and 44.6% of California residents report speaking a language other than English at home. In Los Angeles County, where this study took place, the proportion of residents who are LEP in some communities is higher than 50%
Results
We interviewed 14 providers, including 1 pharmacy technician, 6 pharmacists, 3 nurses, and 4 physicians as part of this study. Data on the interviewees is included in Table 1. Our interviewees were 64% female and had a median of 9.5 years of work experience after clinical training (range: 6–21). Interviews lasted 60–90 min. We identified six major themes across our qualitative data.
- 1.
Perceptions of lack of time and urgent issues led to the use of informal interpreters by physicians and nurses,
Discussion
In this qualitative descriptive study of clinicians working in a tertiary care hospital in Southern California, we found that nurses and physicians used informal interpreters when perceiving lack of time and high workloads. We also found issues of trust from patients around both formal interpreters and healthcare professionals, as older patients in particular preferred family members to interpret. Finally, we found strong preferences for virtual and in-person interpreter services over
Funding
This work was supported by the National Institutes of Aging, grant numbers 3R01AG058911–03S1, R01AG058911, and K01AG076865.
Credit author statement
MSK conceived of the study idea, conceptualized the study design, conducted the interviews, analysed the data, and wrote and edited the manuscript. JCB conduced the literature review, co-conducted the interviews and co-analysed the data.
Declaration of Competing Interest
The authors have no interest to disclose.
References (46)
- et al.
Language barriers and patient safety risks in hospital care. A mixed methods study
Int J Nurs Stud
(2016) - et al.
The pharmacist discharge care (PHARM-DC) study: a multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization
Contemp Clin Trials
(2021) - et al.
Hospital discharge preparedness for patients with limited English proficiency: a mixed methods study of bedside interpreter-phones
Patient Educ Couns
(2018) - et al.
Role conflict among ‘culture brokers’: the experience of native Canadian medical interpreters
Soc Sci Med
(1984) - et al.
Audio-recorded discharge instructions for limited english proficient parents: a pilot study
Jt Comm J Qual Patient Saf
(2019) - et al.
Occupational burnout syndrome and post-traumatic stress among healthcare professionals during the novel coronavirus disease 2019 (COVID-19) pandemic
Best Pract Res Clin Anaesthesiol
(2020) - et al.
The limited english proficient population: describing medicare, medicaid, and dual beneficiaries
Health Equity
(2018) - et al.
Low health literacy, limited english proficiency, and health status in asians, latinos, and other racial/ethnic groups in California
J Health Commun 17(sup3)
(2012) - et al.
Are language barriers associated with serious medical events in hospitalized pediatric patients?
Pediatrics
(2005) Strategies for overcoming language barriers in healthcare
Nurs Manag
(2018)