Implementing medication reconciliation from the planner’s perspective: a qualitative study

Abstract

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.

Prescripción inadecuada de medicamentos: aportaciones de los paradigmas científicos a su conocimiento

“…Los artículos interpretativos trabajan desde perspectivas teóricas variadas, donde el modelo de causalidad de accidentes de Reason es la más frecuente (Ajemigbitse et al, 2013;Slight et al, 2013). Estos trabajos aportan la visión de los actores que participan en la prescripción inadecuada de medicamentos, principalmente del personal médico (Ajemigbitse et al, 2013;Duncan et al, 2012;Sanchez et al, 2014;Slight et al, 2013) y farmacéutico (Latif;Pollock;Boardman, 2011), aunque otros profesionales de la salud también están involucrados en este problema.…”

“…Los resultados de estos estudios evidencian situaciones que participan en la génesis del error médico, como distractores ambientales (Ajemigbitse et al, 2013;Duncan et al, 2012;Slight et al, 2013), presiones laborales (Ajemigbitse et al, 2013;Duncan et al, 2012;Slight et al, 2013), arquitectura de software deficiente (Slight et al, 2013), falta de supervisión (Ajemigbitse et al, 2013;Latif;Pollock;Boardman, 2011;Sanchez et al, 2014) y retroalimentación (Ajemigbitse et al, 2013;Slight et al, 2013), ausencia de guías de práctica clínica en la unidad médica (Ajemigbitse et al, 2013), co-manejo de pacientes (Ajemigbitse et al, 2013), falta de colaboración entre pares (Ajemigbitse et al, 2013;Slight et al, 2013) y otros profesionales de la salud (Ajemigbitse et al, 2013), entre otros factores que explican la variabilidad en la efectividad de las intervenciones realizadas desde el positivismo (Lenander et al, 2014;Rinke et al, 2014) para solucionar el problema, que desde su concepción no inciden sobre las condiciones informadas en el paradigma interpretativo por los protagonistas del problema.…”

Identifying Barriers and Facilitators of 13 mHealth Projects in North America and Africa: Protocol for a 5-Year Implementation Science Study (Preprint)

“…This framework can therefore be adapted and used to guide the design of mHealth interventions for particular settings, as well as the study of their implementation. An increasing number of implementation studies have used PROTOCOL 4 | P a g e CFIR, some as an evaluation framework [26][27] [28] , some for detecting factors influencing implementation [29][30], and some for classifying these influencing factors as facilitators or barriers [20] [27]. To date, only a few studies have had the evaluation of CFIR as a specific aim [31][32] [20].…”

A review of technology-induced error and waste in medication reconciliation

“…Medication reconciliation is the process of identifying the most accurate list of patient medications (including name, dosage, frequency and method of administration) in order to provide correct medications for patients in the health care system [4,9,15,16,17].…”