Nurses describe enabling factors for virtual medication histories

Nurses and midwives working in a metropolitan virtual hospital in Sydney said that obtaining a Best Possible Medication History, or BPMH, can become a viable extension of nursing practice when it is supported by clear roles, structured education, timely feedback and integrated systems. A qualitative study of 15 accredited virtual-care clinicians found that participants initially expressed uncertainty about role boundaries and accountability but progressively viewed BPMH as valuable and relevant to their work.

The research examined how clinicians experienced obtaining BPMHs for patients in a virtual-care setting, including the factors that helped or hindered the activity. It was not designed to measure patient outcomes, medication errors or the effectiveness of nurse-led BPMH. Instead, it focused on nurses’ perspectives, perceived enablers, challenges and implications for organizing virtual care around this responsibility.

Researchers conducted semi-structured interviews between March and July 2025 at a metropolitan virtual hospital in Sydney, Australia. Eligible participants were accredited virtual-care nurses and midwives who had independently performed BPMHs. Fifteen of 21 eligible clinicians participated, representing a highly experienced workforce with a mean of 18 years of nursing experience and four years of virtual-care experience.

Interview questions were informed by selected domains from the Theoretical Domains Framework. The researchers analyzed the interview data inductively using Braun and Clarke’s six-phase thematic analysis. Three themes emerged: collaboration and workflow integration, education and feedback, and challenges. The findings describe the participants’ experiences and views rather than demonstrating a measured improvement in clinical safety.

Collaboration and workflow integration were central to the first theme. Participants described uncertainty at the outset about the boundaries of their role and who was accountable for different parts of the BPMH process. As their experience developed, they came to see BPMH as a relevant extension of nursing practice. Their accounts indicated that embedding the activity within established workflows and providing multidisciplinary governance and support were important to making it practical.

Education and feedback formed the second theme. Participants regarded practical, scenario-based learning and timely feedback as critical for skill development and for integrating BPMH into virtual-care work sustainably. The study did not compare different training approaches or test whether the training produced measurable changes in competence, confidence or consistency. It instead identifies what participants perceived as necessary support for nurse-led BPMH work.

The challenges theme captured several conditions that complicated virtual BPMH activities. Participants identified patient acuity, patients’ varying digital literacy, limited visual assessment during consultations, fragmented communication, workload pressures and insufficient protected time for comprehensive BPMH work. These were reported operational difficulties, not measured causes of medication discrepancies or medication-related harm. The study also did not compare remote medication-history practices with those conducted in physical care settings.

Within the study’s scope, the results support the conclusion that nurse-led BPMH is feasible in a virtual-care setting when backed by multidisciplinary governance, structured education and integrated support systems. The evidence comes from the experiences of 15 nurses and midwives at one metropolitan virtual hospital, so the findings may not represent every virtual-care service or patient population. Because the interviews did not assess clinical effectiveness or patient outcomes, the research cannot establish that the proposed conditions reduce medication discrepancies or medication-related harm.

Subject of Research: Nurses’ experiences and implementation challenges in obtaining medication histories during virtual care

Article Title: Nurses’ perspectives on obtaining best possible medication histories in a virtual care setting: a qualitative study

Article References: Zhang, V. Z., Pham, M., Boscolo, A., Armour, K., & Francis, M. (2026). Nurses’ perspectives on obtaining best possible medication histories in a virtual care setting: a qualitative study. BMC Health Services Research, 26(1), Article 1320. https://doi.org/10.1186/s12913-026-15504-z

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15504-z

Keywords: virtual care, medication reconciliation, nursing practice, BPMH, telehealth, qualitative research, clinical education, workflow integration, patient safety, Nurses, perspectives, obtaining