Medication safety is a key contribution to patient safety in health care settings. Health care researchers and scholars frequently report and discuss nurses medication administration practices or medication errors associated with patients safety in hospitals. Yet there are gaps in published reports about how practitioners view the larger phenomenon of medication safety as it unfolds on a hospital unit. Research is needed to advance our understanding of medication safety as it comes together amidst the interrelated elements in a complex hospital environment, and what practitioners identify and associate with medication safety in this context. In this study, medication safety was explored with participants from nursing and pharmacy departments on one Canadian hospital unit. Using a restorative theoretical approach and citizen science methodology, the researcher engaged in critical conversations with practitioner and decision-maker participants (n=68) to explore elements that support and those that present barriers to medication safety through focus groups, photo walkabouts, on-unit observations, and photo elicitation. Themes from the data revealed that (1) unit structures shape medication safety, (2) medication system design affects medication safety, (3) practitioners embed accountability for medication safety into their practice and processes, (4) unit culture influences medication safety, (5) practitioners devise and employ workarounds to circumvent ongoing barriers to medication safety, and (6) participants envisioned, and in some cases implemented, restorations to improve medication safety on their unit. Findings highlight a range of contextual, interrelated supports for and barriers to medication safety that participants discovered and shared knowledge about on their unit. Participants envisioned medication safety improvements that could be implemented at present and in the future. Workarounds, power, and possibilities for medication safety improvements related to current medication system design in health care systems are discussed.

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