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.
Highlights
Medication reconciliation can reduce adverse events associated with prescribing errors at transitions between sites of care
We report on factors affecting implementation from the perspectives of those involved in planning, including physician managers, nurse managers, quality specialists, pharmacy managers, information technologists
Theme 1 Respondents recognized the value of medication reconciliation in improving patient safety and reducing medication errors, but respondents had a broader view of its value that motivated them to contribute to the planning process
Summary
Medication reconciliation can reduce adverse events associated with prescribing errors at transitions between sites of care. Medication reconciliation is the process of creating a best possible list of medications being used by a patient and comparing that list with the provider’s admission, transfer, and/or discharge orders. This occurs in 3 steps: verification (collecting the patient’s medication history), clarification (ensuring that the medications and doses are appropriate), and reconciliation (documenting changes in the orders) [8,9]. A systematic review suggests that the most effective medication reconciliation interventions are those that utilize pharmacy staff and focus on patients at high risk for adverse events [6]
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