Challenges and Strategies for Patient Safety in Primary Care: A Qualitative Study

Yuan, Christina T.; Dy, Sydney M.; Lai, Alden Yuanhong; Oberlander, Tyler; Hannum, Susan M.; Lasser, Elyse C.; Heughan, JaAlah-Ai; Dukhanin, Vadim; Kharrazi, Hadi; Kim, Julia M.; Gürses, Ayşe P.; Bittle, Mark J.; Scholle, Sarah Hudson; Marsteller, Jill A.

doi:10.1097/jmq.0000000000000054

Cited by 4 publications

(2 citation statements)

References 20 publications

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“…Furthermore, the lack of interoperability between EHR systems can be a major barrier in obtaining the most accurate and updated medication lists. 32 These patient safety issues are critical, especially since none of the clinics in the study reported having CDS features such as drug-drug interaction checking implemented into their electronic medication reconciliation processes.…”

Section: Discussionmentioning

confidence: 99%

How Safe are Outpatient Electronic Health Records? An Evaluation of Medication-Related Decision Support using the Ambulatory Electronic Health Record Evaluation Tool

Co,

Classen,

Cole

et al. 2023

Appl Clin Inform

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Background The purpose of the Ambulatory Electronic Health Record (EHR) Evaluation Tool is to provide outpatient clinics with an assessment that they can use to measure the ability of the EHR system to detect and prevent common prescriber errors. The tool consists of a medication safety test and a medication reconciliation module. Objectives The goal of this study was to perform a broad evaluation of outpatient medication-related decision support using the Ambulatory EHR Evaluation Tool. Methods We performed a cross-sectional study with 10 outpatient clinics using the Ambulatory EHR Evaluation Tool. For the medication safety test, clinics were provided test patients and associated medication test orders to enter in their EHR, where they recorded any advice or information they received. Once finished, clinics received an overall percentage score of unsafe orders detected and individual order category scores. For the medication reconciliation module, clinics were asked to electronically reconcile two medication lists, where modifications were made by adding and removing medications and changing the dosage of select medications. Results For the medication safety test, the mean overall score was 57%, with the highest score being 70%, and the lowest score being 40%. Clinics performed well in the drug allergy (100%), drug dose daily (85%), and inappropriate medication combinations (74%) order categories. Order categories with the lowest performance were drug laboratory (10%) and drug monitoring (3%). Most clinics (90%) scored a 0% in at least one order category. For the medication reconciliation module, only one clinic (10%) could reconcile medication lists electronically; however, there was no clinical decision support available that checked for drug interactions. Conclusion We evaluated a sample of ambulatory practices around their medication-related decision support and found that advanced capabilities within these systems have yet to be widely implemented. The tool was practical to use and identified substantial opportunities for improvement in outpatient medication safety.

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Section: Discussionmentioning

confidence: 99%

How Safe are Outpatient Electronic Health Records? An Evaluation of Medication-Related Decision Support using the Ambulatory Electronic Health Record Evaluation Tool

Co,

Classen,

Cole

et al. 2023

Appl Clin Inform

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“…Within these domains, we identified key factors from the adapted CFIR based on models of ambulatory patient safety, 4,5 the National Committee for Quality Assurance (NCQA) PCMH standards 20 and our previously reported exploratory research on patient safety in the PCMH with multimodal qualitative in-depth in-person site visits with 10 diverse level 3 PCMH practices across 4 states. 21…”

mentioning

confidence: 99%

Association of Implementation and Social Network Factors With Patient Safety Culture in Medical Homes: A Coincidence Analysis

Acton

Yuan

et al. 2020

J Patient Saf

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Objectives:The patient-centered medical home (PCMH) may provide a key model for ambulatory patient safety. Our objective was to explore which PCMH and patient safety implementation and social network factors may be necessary or sufficient for higher patient safety culture.Methods: This was a cross-case analysis study in 25 diverse U.S.PCMHs. Data sources included interviews of a clinician and an administrator in each PCMH, surveys of clinicians and staff, and existing data on the PCMHs' characteristics. We used coincidence analysis, a novel method based on set theory and Boolean logic, to evaluate relationships between factors and the implementation outcome of patient safety culture. Results:The coincidence analysis identified 5 equally parsimonious solutions (4 factors), accounting for all practices with higher safety culture. Three solutions contained the same core minimally sufficient condition: the implementation factor leadership priority for patient safety and the social network factor reciprocity in advice-seeking network ties (advice-seeking relationships). This minimally sufficient condition had the highest coverage (5/7 practices scoring higher on the outcome) and best performance across solutions; all included leadership priority for patient safety. Other key factors included self-efficacy and job satisfaction and quality improvement climate. The most common factor whose absence was associated with the outcome was a well-functioning process for behavioral health.Conclusions: Our findings suggest that PCMH safety culture is higher when clinicians and staff perceive that leadership prioritizes patient safety and when high reciprocity among staff exists. Interventions to improve patient safety should consider measuring and addressing these key factors.

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Navigating the complex terrain of patient safety: challenges, strategies, and the importance of ongoing evaluation and knowledge sharing

Macleod,

Greenfield

2024

International Journal for Quality in Health Care

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Challenges and Strategies for Patient Safety in Primary Care: A Qualitative Study

Cited by 4 publications

References 20 publications

How Safe are Outpatient Electronic Health Records? An Evaluation of Medication-Related Decision Support using the Ambulatory Electronic Health Record Evaluation Tool

How Safe are Outpatient Electronic Health Records? An Evaluation of Medication-Related Decision Support using the Ambulatory Electronic Health Record Evaluation Tool

Association of Implementation and Social Network Factors With Patient Safety Culture in Medical Homes: A Coincidence Analysis

Navigating the complex terrain of patient safety: challenges, strategies, and the importance of ongoing evaluation and knowledge sharing

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