Implementation strategies in the context of medication reconciliation: a qualitative study

Deonni P Stolldorf,Mary S Dietrich,Timothy J Vogus,Jeffrey L Schnipper,Sheila H Ridner,Christianne L Roumie,Sunil Kripalani,David G Schlundt

doi:10.1186/s43058-021-00162-5

Abstract

BackgroundMedication reconciliation (MedRec) is an important patient safety initiative that aims to prevent patient harm from medication errors. Yet, the implementation and sustainability of MedRec interventions have been challenging due to contextual barriers like the lack of interprofessional communication (among pharmacists, nurses, and providers) and limited organizational capacity. How to best implement MedRec interventions remains unclear. Guided by the Expert Recommendations for Implementing Change (ERIC) taxonomy, we report the differing strategies hospital implementation teams used to implement an evidence-based MedRec Toolkit (the MARQUIS Toolkit).MethodsA qualitative study was conducted with implementation teams and executive leaders of hospitals participating in the federally funded “Implementation of a Medication Reconciliation Toolkit to Improve Patient Safety” (known as MARQUIS2) research study. Data consisted of transcripts from web-based focus groups and individual interviews, as well as meeting minutes. Interview data were transcribed and analyzed using content analysis and the constant comparison technique.ResultsData were collected from 16 hospitals using 2 focus groups, 3 group interviews, and 11 individual interviews, 10 sites’ meeting minutes, and an email interview of an executive. Major categories of implementation strategies predominantly mirrored the ERIC strategies of “Plan,” “Educate,” “Restructure,” and “Quality Management.” Participants rarely used the ERIC strategies of finance and attending to policy context. Two new non-ERIC categories of strategies emerged—“Integration” and “Professional roles and responsibilities.” Of the 73 specific strategies in the ERIC taxonomy, 32 were used to implement the MARQUIS Toolkit and 11 new, and non-ERIC strategies were identified (e.g., aligning with existing initiatives and professional roles and responsibilities).ConclusionsComplex interventions like the MARQUIS MedRec Toolkit can benefit from the ERIC taxonomy, but adaptations and new strategies (and even categories) are necessary to fully capture the range of approaches to implementation.

Highlights

Medication reconciliation (MedRec) is an important patient safety initiative that aims to prevent patient harm from medication errors
Identifies the strategies most commonly used in implementing medication reconciliation (MedRec) interventions, an important patient safety initiative
Members of MARQUIS2 hospitals reported using a variety of implementation strategies during MARQUIS Toolkit implementation, 32 of which aligned with the Expert Recommendations for Implementing Change (ERIC) taxonomy and the plan, educate, restructure, and quality management categories (Table 2)

Summary

Introduction

Medication reconciliation (MedRec) is an important patient safety initiative that aims to prevent patient harm from medication errors. It requires extensive use of resources [8, 16], wide-scale organizational change [17,18,19], interprofessional collaboration [20], and workflow redesign [8, 16, 19, 21, 22] Reports demonstrate these complexities create multiple barriers to successful MedRec implementation including a lack of role clarity, insufficient interprofessional collaboration, and limited organizational capacity including personnel resources and time commitments [10, 19, 22,23,24,25]. Careful consideration of how MedRec interventions are implemented and deployed in hospitals may help future efforts to overcome initial implementation barriers to successfully adopt MedRec and ensure their long-term sustainability

Methods

Results

Discussion

Conclusion