The Cognitive Task of Medication Reconciliation - Clinicians’ Approaches to the Arrangement of Medical Condition and Medication History Information

2016 ◽  
Vol 60 (1) ◽  
pp. 538-540 ◽  
Author(s):  
Yuval Bitan ◽  
Yisrael Parmet ◽  
Geva Greenfield ◽  
Shelly Teng ◽  
Mark Nunnally
Keyword(s):  
Medication Reconciliation ◽  
Medical Information ◽  
Medical Condition ◽  
Improve Patient Safety ◽  
Cognitive Task ◽  
Clinical Information ◽  
Card Sorting ◽  
Medication History ◽  
Disease Information ◽  
Improve Patient

We report the results of a study which aims to improve our understanding of how clinicians make sense of medication and disease information (medical reconciliation), performed by clinicians in a major US hospital. A card sorting simulation experiment running on an Android tablet was utilized to record the steps taken by 130 clinicians to reconcile and better understand the clinical information they received about a simulated patient. Evaluating the order in which the clinicians processed the information shows that most clinicians sorted medical condition information before medication history. Clinicians use diverse strategies to arrange the information. This study allows us to expend our understanding of the cognitive task of medication reconciliation, adding to the knowledge that might assist in data presentation in future medical information software. Such an understanding has the potential to provide clinicians with better tools to capture and reconcile clinical information which may ultimately improve patient safety.

scholarly journals A web application to involve patients in the medication reconciliation process: a user-centered usability and usefulness study

2018 ◽  
Vol 25 (11) ◽  
pp. 1488-1500
Author(s):  
Sophie Marien ◽  
Delphine Legrand ◽  
Ravi Ramdoyal ◽  
Jimmy Nsenga ◽  
Gustavo Ospina ◽  
...  
Keyword(s):  
Web Application ◽  
Medication Reconciliation ◽  
Qualitative Data ◽  
Improve Patient Safety ◽  
Three Dimensions ◽  
Medication List ◽  
Medication History ◽  
Medication Discrepancies ◽  
System Usability Scale ◽  
User Centered

Abstract Objective Medication reconciliation (MedRec) can improve patient safety by resolving medication discrepancies. Because information technology (IT) and patient engagement are promising approaches to optimizing MedRec, the SEAMPAT project aims to develop a MedRec IT platform based on two applications: the “patient app” and the “MedRec app.” This study evaluates three dimensions of the usability (efficiency, satisfaction, and effectiveness) and usefulness of the patient app. Methods We performed a four-month user-centered observational study. Quantitative and qualitative data were collected. Participants completed the system usability scale (SUS) questionnaire and a second questionnaire on usefulness. Effectiveness was assessed by measuring the completeness of the medication list generated by the patient application and its correctness (ie medication discrepancies between the patient list and the best possible medication history). Qualitative data were collected from semi-structured interviews, observations and comments, and questions raised by patients. Results Forty-two patients completed the study. Sixty-nine percent of patients considered the patient app to be acceptable (SUS Score ≥ 70) and usefulness was high. The medication list was complete for a quarter of the patients (7/28) and there was a discrepancy for 21.7% of medications (21/97). The qualitative data enabled the identification of several barriers (related to functional and non-functional aspects) to the optimization of usability and usefulness. Conclusions Our findings highlight the importance and value of user-centered usability testing of a patient application implemented in “real-world” conditions. To achieve adoption and sustained use by patients, the app should meet patients’ needs while also efficiently improving the quality of MedRec.

Prescribing in the prehospital environment: a review of the pharmaceutical Module 501 on UK Military Exercise SAIF SAREEA 3. Can such analysis assist with the scaling of healthcare assets?

2020 ◽  
Vol 166 (6) ◽  
pp. 387-390
Author(s):  
L G Davies ◽  
D C Thompson ◽  
R Gillett ◽  
M B Smith
Keyword(s):  
Medical Information ◽  
Improve Patient Safety ◽  
Treatment Team ◽  
Prehospital Treatment ◽  
Record Keeping ◽  
Deployment Planning ◽  
Medical Planning ◽  
Desert Climate ◽  
Improve Patient ◽  
Regular Review

IntroductionModule 501 provides core medications which are fundamental to the capability of a prehospital treatment team (PHTT). The quantities of each medication in the module inventory undergo regular review, but these do not correspond to a population at risk (PAR) figure or deployment length for which they intend to be used. This article proposes how the quantities of Module 501 drugs can be scaled for a given deployment, in this example using statistics taken from static PHTTs on Exercise Saif Sareea 3 (SS3).MethodsThe statistics were gathered using a custom-built search of electronic records from the Deployed Defence Medical Information Capability Programme in addition to written record-keeping, which were aligned to the weekly PAR at each PHTT location throughout their full operational capability periods. A quotient was then derived for each module item using a formula.ResultsAmong the 10 most commonly prescribed drugs were four analgesics and three antimicrobials. 42 of the 110 studied drugs were not prescribed during SS3.DiscussionThe data from SS3 reflect the typical scope of disease encountered in the deployed land setting. Employing these data, the use of a formula to estimate the drug quantities needed to sustain a Strike Armoured Infantry Brigade over a 28-day period is demonstrated.RecommendationsFurther study of Module 501 across varied deployment environments would be valuable in evolving this approach to medicinal scaling if proven effective for the warm desert climate. It could then be applied to other modules to further inform future Strike medical planning.LimitationsSeveral considerations when drawing deductions from the data are mentioned, including the inaccuracy of predictor variables taken from the EpiNATO-2 reports.ConclusionThe proposed formula provides an evidence-based framework for scaling drug quantities for a deployment planning. This may improve patient safety and confer logistical, storage and fiscal benefits.

scholarly journals Medication Reconciliation And Inpatient Fall: Identifying Ways To Improve Patient Safety

2016 ◽  
Vol 19 (3) ◽  
pp. A289
Author(s):  
W. Agbor Bawa ◽  
N. Rianon ◽  
B. Melton ◽  
J. Chen ◽  
R. Rasu
Keyword(s):  
Patient Safety ◽  
Medication Reconciliation ◽  
Improve Patient Safety ◽  
Improve Patient

Contrasting discourse styles and barriers to patient participation in bedside nursing handovers

2017 ◽  
Vol 13 (1) ◽  
Author(s):  
Suzanne Eggins ◽  
Diana Slade
Keyword(s):  
Discourse Analysis ◽  
Public Hospital ◽  
Systemic Functional Linguistics ◽  
Improve Patient Safety ◽  
Clinical Information ◽  
Communication Training ◽  
Communicative Practice ◽  
Bedside Nursing ◽  
Improve Patient ◽  
Shift Change

This paper applies qualitative discourse analysis to ‘shift-change handovers’, events in which nurses hand over care for their patients to their colleagues. To improve patient safety, satisfaction and inclusion, hospitals increasingly require nursing staff to hand over at the patient’s bedside, rather than in staff-only areas. However, bedside handover is for many a new and challenging communicative practice. To evaluate how effectively nurses achieve bedside handover, we observed, audio-recorded and transcribed nursing shift-change handovers in a short stay medical ward at an Australian public hospital. Drawing on discourse analysis influenced by systemic functional linguistics we identify four handover styles: exclusive vs inclusive and objectifying vs agentive. The styles capture interactional/interpersonal meaning choices associated with whether and how nurses include patients during handover, and informational/ideational meaning choices associated with whether or not nurses select and organise clinical information in ways that recognise patients’ agency. We argue that the co-occurrence of inclusive with agentive and exclusive with objectifying styles demonstrates that how nurses talk about their patients is powerfully influenced by whether and how they also talk to them. In noting the continued dominance of exclusive objectifying styles in handover interactions, we suggest that institutional change needs to be supported by communication training.

scholarly journals Making Sense of the Cognitive Task of Medication Reconciliation Using a Card Sorting Task

2019 ◽  
Vol 61 (8) ◽  
pp. 1315-1325 ◽  
Author(s):  
Yuval Bitan ◽  
Yisrael Parmet ◽  
Geva Greenfield ◽  
Shelly Teng ◽  
Richard I. Cook ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Cognitive Task ◽  
Cognitive Strategies ◽  
Performance Model ◽  
Sorting Task ◽  
Medical Conditions ◽  
Card Sorting ◽  
Conflicting Information ◽  
Card Sorting Task ◽  
New Information

Objective: To explore cognitive strategies clinicians apply while performing a medication reconciliation task, handling incomplete and conflicting information. Background: Medication reconciliation is a method clinicians apply to find and resolve inconsistencies in patients’ medications and medical conditions lists. The cognitive strategies clinicians use during reconciliation are unclear. Controlled lab experiments can explore how clinicians make sense of uncertain, missing, or conflicting information and therefore support the development of a human performance model. We hypothesize that clinicians apply varied cognitive strategies to handle this task and that profession and experience affect these strategies. Method: 130 clinicians participated in a tablet-based experiment conducted in a large American teaching hospital. They were asked to simulate medication reconciliation using a card sorting task (CaST) to organize medication and medical condition lists of a specific clinical case. Later on, they were presented with new information and were asked to add it to their arrangements. We quantitatively and qualitatively analyzed the ways clinicians arranged patient information. Results: Four distinct cognitive strategies were identified (“Conditions first”: n = 76 clinicians, “Medications first”: n = 7, “Crossover”: n = 17, and “Alternating”: n = 10). The strategy clinicians applied was affected by their experience ( p = .02) but not by their profession. At the appearance of new information, clinicians moved medication cards more frequently (75.2 movements vs. 49.6 movements, p < .001), suggesting that they match medications to medical conditions. Conclusion: Clinicians apply various cognitive strategies while reconciling medications and medical conditions. Application: Clinical information systems should support multiple cognitive strategies, allowing flexibility in organizing information.

scholarly journals Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Amanda S. Mixon ◽  
◽  
G. Randy Smith ◽  
Meghan Mallouk ◽  
Harry Reyes Nieva ◽  
...  
Keyword(s):  
Best Practices ◽  
Medication Reconciliation ◽  
Improve Patient Safety ◽  
Lessons Learned ◽  
Medication History ◽  
Medication Discrepancies ◽  
Roles And Responsibilities ◽  
Medical Centers ◽  
Phone Calls ◽  
Barriers To Implementation

Abstract Background The first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1. Methods MARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site’s local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient. Discussion A mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation.

scholarly journals Development and Evaluation of Medication Reconciliation Checklist Tool to Improve Patient Safety

2020 ◽  
Vol 5 (3) ◽  
pp. 50
Author(s):  
SZ Inamdar ◽  
GSri Lakshmi ◽  
K Pradeepthi ◽  
RV Kulkarni ◽  
RB Kotnal
Keyword(s):  
Patient Safety ◽  
Medication Reconciliation ◽  
Improve Patient Safety ◽  
Improve Patient

299 Implementing A Formal Surgical Handover Tool for Junior Doctors – A QI Approach

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Gill ◽  
S Quested ◽  
J Lim ◽  
M Mohsin
Keyword(s):  
Improve Patient Safety ◽  
Clinical Information ◽  
Surgical Patient ◽  
Junior Doctors ◽  
Post Intervention ◽  
Perceived Safety ◽  
Surgical Department ◽  
Safe Patient Care ◽  
Improve Patient ◽  
Patient Handovers

Abstract Introduction An informative medical handover facilitates safe patient care. It was recognized that insufficient clinical information at handover resulted in unsafe communication in the general surgical department at Pinderfields General Hospital (PGH). We aim to utilise the Royal College of Surgeons’ (RCS) and British Medical Association’s (BMA) guidelines to improve the existing handover system, facilitate an efficient and relevant handover, and furthermore improve patient safety. Method General surgical foundation doctors (FDs) (n = 15) at PGH were surveyed to establish their perspectives of existing handover documentation. Subsequently a handover tool was iteratively designed, using tests of change, combining RCS and BMA guidelines with FDs’ suggestions of patient information required for safe handover. At two time points, FDs in the department were re-surveyed to measure improvement. Results Prior to implementation of a formal document, only 20% of FDs reported sufficient patient identifiers of the handover. This improved to 67% post intervention. Pre-intervention, 0% perceived the handover as ‘Excellent’, 20% as ‘good’. Post-intervention, these improved to 34% and 60% respectively. Conclusions Over six months, we improved the FD’s handover document, resulting in positive feedback of perceived safety of surgical patient handovers. However, recognised time constraints have highlighted the need for more efficient handover documentation.

Sign in / Sign up

Export Citation Format

Share Document