Nurses’ perspectives on obtaining best possible medication histories in a virtual care setting: a qualitative study
TL;DR
Nurses initially expressed uncertainty regarding role boundaries and accountability but progressively viewed BPMH as a valuable and relevant extension of nursing practice, and novel insights into a scalable nurse-led BPMH workforce model within virtual care are provided.
Abstract
Medication discrepancies during transitions of care are a major and preventable source of medication-related harm. A Best Possible Medication History (BPMH) is a critical first step in medication reconciliation and risk mitigation. While nurses are increasingly recognised as contributors to medication safety, limited evidence has explored their experiences obtaining BPMHs within a virtual care setting. This study aims to explore nurses’ perspectives on obtaining BPMHs for patients in a virtual care setting, including perceived enablers, challenges, and implications for practice optimisation. A qualitative study was undertaken at a metropolitan virtual hospital in Sydney, Australia. Semi-structured interviews were conducted between March and July 2025 with accredited virtual care nurses and midwives who had independently performed BPMHs. Interview questions were informed by selected domains from the Theoretical Domains Framework, and data were analysed inductively using Braun and Clarke’s six-phase thematic analysis. Fifteen of twenty-one eligible nurses participated. Participants represented a highly experienced nursing workforce with a mean of 18 years of nursing experience and 4 years of virtual care experience. Three themes were identified: (1) Collaboration and workflow integration, (2) Education and feedback, and (3) Challenges. Nurses initially expressed uncertainty regarding role boundaries and accountability but progressively viewed BPMH as a valuable and relevant extension of nursing practice. Practical scenario-based learning and timely feedback were perceived as critical to skill development and sustainable workflow integration. Key challenges included patient acuity, digital literacy, limited visual assessment during consultations, fragmented communication, workload pressures, and limited protected time for comprehensive BPMH activities. Nurse-led BPMH is feasible in a virtual care setting when supported by multidisciplinary governance, structured education, and integrated support systems. This study provides novel insights into a scalable nurse-led BPMH workforce model within virtual care.