BACKGROUND:Medication reconciliation can prevent medication errors and harm when patients transition between hospital and other care settings. Though a Joint Commission hospital Patient Safety Goal since 2006, organizations continue to have difficulty implementing the process.OBJECTIVE:To determine factors that influence performance of medication reconciliation in a hospital setting with a computerized medication reconciliation tool.DESIGN:Cognitive task analysis (CTA) and focus group interviews.SETTING:Urban, academic, tertiary‐care Veterans Affairs medical center.PARTICIPANTS:Internal medicine house staff physicians (n = 23) and inpatient staff pharmacists (n = 12).MEASUREMENTS:CTA participants verbalized their thoughts while they completed medication reconciliation with the computerized tool. Focus group participants described medication reconciliation's purpose and effectiveness, how they completed the task, and its barriers and facilitators. Interviews were recorded and analyzed using social science methods for analyzing qualitative data.RESULTS:Participants agreed that a central goal of medication reconciliation is to prevent prescribing errors, but disagreed about whether it achieves this goal. Computerization facilitated the task, but participants said that computers and patients can be unreliable sources of information. Participants varied in how they sequenced components of the task. When time was limited, physicians considered other responsibilities higher priority. Both physicians and pharmacists expressed low self‐efficacy, ie, low perceived capability to achieve the objectives of the process.CONCLUSION:Key barriers to medication reconciliation are unreliable sources of medication information and tasks that compete for providers' time and attention that they consider higher priority. Addressing these barriers while increasing providers' self‐efficacy might improve medication reconciliation and its outcomes. Journal of Hospital Medicine 2011;6:329–337. © 2011 Society of Hospital Medicine

The role of risk communication and public participation in environmental and public policy decision making has significantly increased over the last 15 years and remains an important social policy issue. In spite of this emphasis, government officials and participants in the process continue to struggle with what makes for "good" public participation. This study used two frameworks--one theoretical and one participant-based-to evaluate two U.S Army Restoration Advisory Boards (RABs). The theoretical framework explores the extent to which the RABs facilitate Habermas's idealized conditions of speech as related to fairness. Not surprisingly, we found that the two RABs do not consistently foster the idealized aspects of fairness suggested by Habermas. The participant-based criteria were elicited through interviews with participants from the various stakeholder groups represented on the RAB, direct observation of RAB meetings, and a review of RAB-related documents. We found that participants' value outcomes (the results of participatory processes) and not just the process itself, which is the focus of the theoretical framework. We also found that participants in the various stakeholder groups had different perceptions of the goals of the participatory process, which were closely related to their notions of success. Our results illustrate both the complexity and importance of using multiple frameworks for evaluating participatory efforts and the need for more systematic evaluation.

BackgroundMedication reconciliation can reduce adverse events associated with prescribing errors at transitions between sites of care. Though a U.S. Joint Commission National Patient Safety Goal since 2006, at present organizations continue to have difficulty implementing it. The objective of this study was to examine medication reconciliation implementation from the perspective of individuals involved in the planning process in order to identify recurrent themes, including facilitators and barriers, that might inform other organizations’ planning and implementation efforts.MethodsWe performed semi-structured interviews with individuals who had a role in planning medication reconciliation implementation at a large urban academic medical center in the U.S. and its affiliated Veterans Affairs hospital. We queried respondents’ perceptions of the implementation process and their experience with facilitators and barriers. Transcripts were coded and analyzed using a grounded theory approach. The themes that emerged were subsequently categorized using the Consolidated Framework for Implementation Research (CFIR).ResultsThere were 13 respondents, each with one or more organizational roles in quality improvement, information technology, medication safety, and education. Respondents described a resource- and time- intensive medication reconciliation planning process. The planning teams’ membership and functioning were recognized as important factors to a successful planning process. Implementation was facilitated by planners’ understanding of the principles of performance improvement, in particular, fitting the new process into the workflow of multiple disciplines. Nevertheless, a need for significant professional role changes was recognized. Staff training was recognized to be an important part of roll-out, but training had several limitations. Planners monitored compliance to help sustain the process, but acknowledged that this did not ensure that medication reconciliation actually achieved its primary goal of reducing errors. Study findings fit multiple constructs in the CFIR model.ConclusionsStudy findings suggest that to improve the likelihood of a successful implementation of medication reconciliation, planners should, among other considerations, involve a multidisciplinary planning team, recognize the significant professional role changes that may be needed, and consider devoting resources not just to compliance monitoring but also to monitoring of the process’ impact on prescribing.