Nursing Management Strategies for Promoting the Rational and Safe Use of Medications in Primary Health Care: A Qualitative Study

Abstract

Introduction

Adverse events associated with medication use constitute a significant patient safety problem globally. In Primary Health Care, nurses play a central role in managing the medication pathway, integrating clinical, organizational, and leadership responsibilities that directly influence the promotion of the Rational and Safe Use of Medicines (RSM). However, evidence regarding the organizational strategies adopted by nurses in this care context remains limited.

Objective

To identify the strategies to be adopted by nurses responsible for medication management to promote the rational and safe use of medicines in primary health care.

Methods

This descriptive, qualitative study was conducted between June and October 2024. Data collection was carried out using a self-administered questionnaire directed at nurses working in Primary Health Care in Portugal, using the snowball sampling technique. 115 nurses participated. A categorical content analysis was performed based on Bardin's methodological proposal, with pre-analysis, floating reading and organization of the textual material; coding of the recording units and construction of emerging categories and subcategories; and treatment and interpretation of the results through frequency analysis, converting qualitative data into quantitative data. This process was supported by NVivo software, version 11 (QSR International), facilitating systematization, categorization, and structured analysis of the participants' responses. Ethical principles were ensured, including informed consent and approval by the ethics committee.

Results

Three main categories emerged: Organization/Institution, Monitoring/Evaluation, and Standardization/Unification. The strategies identified include valuing continuous training, optimizing logistical processes, implementing internal audits, standardizing practices through protocols and procedures, and promoting structured collective feedback. These strategies highlight the centrality of the organizational dimension in medication safety.

Conclusion

The results reinforce the strategic role of nurse managers in consolidating a safety culture in Primary Health Care, demonstrating that leadership, continuous training, systematic monitoring, and collaborative work are crucial for promoting the rational and safe use of medicines and improving the quality of care.