Barriers in communicating medication changes at hospital discharge: Informing CancelRx design requirements

2021 ◽  
pp. 251604352110059
Author(s):  
Yushi Yang ◽  
Samantha I Pitts ◽  
Allen R Chen
Keyword(s):  
Hospital Discharge ◽  
Medical Center ◽  
Academic Medical Center ◽  
Structured Interviews ◽  
Medication Discontinuation ◽  
Academic Medical ◽  
Receive System ◽  
Design Requirements ◽  
To Receive ◽  
Medication Changes

Objectives This operational study aims to investigate the barriers in communicating medication changes at hospital discharge, and to inform design requirements of the CancelRx functionality to better support the communication. Methods We conducted seven semi-structured interviews with inpatient prescribers at an urban academic medical center. The interview protocol was framed from a human factors perspective, specifically the work system design approach. We took notes of the interviews and identified the initial themes of system barriers that may impact patient safety. Results Medication changes need to be communicated to multiple stakeholders. We identified two initial themes of the system barriers: the lack of an information flow that connects all the involved stakeholders, and the difficulties to communicate key pieces of information. We identified three key pieces of information that are difficult to communicate: the discontinuation reasons, the notification urgency, and the duration of changes. Conclusions While the CancelRx functionality can facilitate the communication (e.g. prescribers no longer need to call pharmacists when a medication is discontinued), enhancements are needed to address the system barriers. We proposed enhanced design requirements of the CancelRx functionality, e.g., to allow users to specify a reason for a medication discontinuation and transmit the reasons to other stakeholders, to indicate the urgency of notification, to specify the duration of a change, and to receive system status feedback .

Screening for expired medications in automated dispensing cabinets

2020 ◽  
Vol 77 (24) ◽  
pp. 2107-2111
Author(s):  
Alexis N Nanni ◽  
Trusha S Rana ◽  
Daniel H Schenkat
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Experimental Period ◽  
Experimental Phase ◽  
Monthly Basis ◽  
Main Campus ◽  
Dose Rates ◽  
Additional Intervention ◽  
Academic Medical ◽  
To Receive

Abstract Purpose Results of a study to quantify rates of identification of expired medications in automated dispensing cabinets (ADCs) are reported. Methods A pre-post analysis was conducted to determine the effect of various types of ADC audits on rates of finding expired medications in ADCs. For the experimental phase of the study, 4 ADCs at the main campus of an academic medical center were randomly assigned to receive one of 4 interventions: (1) monthly audits of all ADC pockets, (2) monthly audits of matrix (open pocket) drawers only, (3) monthly audits of unassigned pockets only, and (4) no additional intervention. Results At baseline, rates of finding expired medication doses in the 4 ADCs ranged from 0.4% to 0.7%. During the 3-month experimental period, rates of finding expired medication doses ranged from 0.1% to 0.3%. During a final audit 1 month later, the ADC targeted for monthly audits of all pockets was found to contain no expired doses, with an overall improvement in expired-dose rates for all audited ADCs observed over the course of the 4-month study. The average time to perform a full audit for an ADC with about 340 pockets was 1 hour, or 15 seconds per pocket. The average time to perform matrix drawer–only audits averaged around 45 minutes, or 11 seconds per pocket. The average time to perform audits of unassigned matrix drawers averaged 30 minutes, or 10 seconds per pocket. Conclusion Auditing of all ADC pockets on a monthly basis appears to be an effective method of reducing the rate of identification of expired medications in ADC pockets.

scholarly journals Difficult Discharges to Skilled Nursing Facilities Attributed to Multiple Sclerosis Medications: An Observational Study

2019 ◽  
Vol 10 (2) ◽  
pp. 82-87
Author(s):  
Kathleen C. Munger ◽  
Benjamin P. George ◽  
Lawrence M. Samkoff ◽  
Jessica F. Robb
Keyword(s):  
Multiple Sclerosis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Medication Costs ◽  
Medication Discontinuation ◽  
Academic Medical

Background: The costs of multiple sclerosis (MS) disease-modifying therapies (DMTs) and certain symptomatic treatments (ie, dalfampridine [DFP]) are high. Consolidated billing models require that medication costs be covered by skilled nursing facilities (SNFs) after hospitalization. As a result, patients may experience suboptimal discharge, off of medication or without rehabilitation. Methods: To characterize the frequency with which MS pharmaceutical costs lead to suboptimal discharge, we performed a retrospective chart review of admissions to a large academic medical center from January 2013 to December 2017 among patients with MS on DMT and/or DFP with SNF rehabilitation recommendations. We quantified the burden of suboptimal discharge due to medication discontinuation, limited medication supplies, or forgone rehabilitation. Results: Among 169 admissions of patients with MS with discharge recommendations for SNF rehabilitation, there were 57 (33.7%) admissions across 49 patients with MS on DMT/DFP. Overall, 39 (68%) of 57 admissions (71% of patients) experienced a suboptimal discharge. Overall, 29 (65%) discontinued DMT/DFP, 9 (16%) took their remaining home supply of medications during rehabilitation (including 5 admissions also affected by a discontinuation), and 6 (11%) were discharged home to remain on DMT. Among those discharged to rehabilitation, discharge to a hospital-owned SNF was associated with a routine discharge with no lapse in medication (n = 11/15 vs 7/36, P < .001). Conclusions: High costs of MS medications in conjunction with SNF consolidated payment models result in misaligned incentives and often lead to medication discontinuation or other suboptimal discharge for patients with MS.

Social and emotional factors and decisions of advanced cancer patients (ACP) to enter an early-phase (EP) clinical trial.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 223-223
Author(s):  
Daniel Paul Dohan ◽  
James Wiley ◽  
Sarah B. Garrett ◽  
Laura Trupin ◽  
Fay J. Hlubocky ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Structured Interviews ◽  
Advanced Cancer Patients ◽  
Social And Emotional ◽  
Emotional Factors ◽  
Academic Medical ◽  
Trial Entry ◽  
Informational Networks

223 Background: We explored how social and emotional factors shaped decisions by ACP to enter an EP trial. Methods: Mixed-methods longitudinal cohort study including validated surveys and open-ended interviews. ACP were recruited at an academic medical center with an EP trials program. Patients were eligible if treating oncologists deemed them likely to exhaust standard treatment in 6-12 months but before being offered EP study enrollment. Surveys measured symptoms, quality of life, decisional preferences, emotions, and demographics. 60 minute semi-structured interviews were audio recorded and transcribed. SAS (statistical) and Atlas.ti (thematic coding) were use for analysis. Results: Of 82 patients in the ACP cohort, 16% went on to initiate EP trial entry. No social and emotional factors were associated with EP initiation except ACP who reported both not “feeling down” and feeling “in control of things in your life” (Table) were more likely to initiate. In interviews, many EP initiates expressed hopefulness and a desire to actively respond to their illness. While none believed they could control their illness, some ACP attributed their sense of control over things to their relationship with their oncologist, and others attributed it to informational networks. Conclusions: A feeling of control and absence of depressive symptoms may be associated with ACP initiation of an EP trial. Further exploration of qualitative data documenting the dynamics of EP decision-making is needed. [Table: see text]

scholarly journals Multi-Level Stakeholder Perspectives on Determinants of Point of Care Ultrasound Implementation in a US Academic Medical Center

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1172
Author(s):  
Anna M. Maw ◽  
Megan A. Morris ◽  
Juliana G. Barnard ◽  
Juliana Wilson ◽  
Russell E. Glasgow ◽  
...  
Keyword(s):  
Medical Center ◽  
Point Of Care ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Point Of Care Ultrasound ◽  
High Fidelity ◽  
Structured Interviews ◽  
Academic Medical ◽  
Multi Level ◽  
Fidelity Implementation

There is growing interest from multiple specialties, including internal medicine, to incorporate diagnostic point of care ultrasound (POCUS) into standard clinical care. However, few internists currently use POCUS. The objective of this study was to understand the current determinants of POCUS adoption at both the health system and clinician level at a U.S. academic medical center from the perspective of multi-level stakeholders. We performed semi-structured interviews of multi-level stakeholders including hospitalists, subspecialists, and hospital leaders at an academic medical center in the U.S. Questions regarding the determinants of POCUS adoption were asked of study participants. Using the framework method, team-based analysis of interview transcripts were guided by the contextual domains of the Practical Robust Implementation and Sustainability Model (PRISM). Thirty-one stakeholders with diverse roles in POCUS adoption were interviewed. Analysis of interviews revealed three overarching themes that stakeholders considered important to adoption by clinicians and health systems: clinical impact, efficiency and cost. Subthemes included two that were deemed essential to high-fidelity implementation: the development of credentialing policies and robust quality assurance processes. These findings identify potential determinants of system and clinician level adoption that may be leveraged to achieve high-fidelity implementation of POCUS applications that result in improved patient outcomes.

scholarly journals A Qualitative Study of Physician Perspectives on Adaptation to Electronic Health Records

2019 ◽  
Author(s):  
Cynthia Judine Sieck ◽  
Nicole Pearl ◽  
Tiffani J. Bright ◽  
Po-Yin Yen
Keyword(s):  
Qualitative Study ◽  
Electronic Health Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Opportunity To Learn ◽  
Structured Interviews ◽  
Health Records ◽  
Physician Perspectives ◽  
Academic Medical ◽  
Electronic Health

Abstract Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation.Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 minutes, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis.Results We identified 4 major themes related to EHR adapation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adapation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaption.Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.

scholarly journals A Qualitative Study of Physician Perspectives on Adaptation to Electronic Health Records

2019 ◽  
Author(s):  
Cynthia Judine Sieck ◽  
Nicole Pearl ◽  
Tiffani J. Bright ◽  
Po-Yin Yen
Keyword(s):  
Qualitative Study ◽  
Electronic Health Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Opportunity To Learn ◽  
Structured Interviews ◽  
Health Records ◽  
Physician Perspectives ◽  
Academic Medical ◽  
Electronic Health

Abstract Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation.Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 minutes, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis.Results We identified 4 major themes related to EHR adapation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adapation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaption.Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.

Continuation Rate of Atypical Antipsychotics After Discharge When Initiated in the Intensive Care Unit

2016 ◽  
Vol 30 (3) ◽  
pp. 342-346 ◽  
Author(s):  
Salia Farrokh ◽  
Amber C. Castle ◽  
Mojdeh Heavner ◽  
Margaret A. Pisani
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Atypical Antipsychotics ◽  
Medical Center ◽  
Academic Medical Center ◽  
Duration Of Treatment ◽  
Academic Medical ◽  
Final Study ◽  
Safety Outcomes

Purpose: The frequency with which atypical antipsychotics initiated in the intensive care unit (ICU) is unknown. While there is lack of evidence to support the exact duration of treatment, antipsychotics should not be continued chronically for agitation and psychosis related to critical illness. The objective of this study was to determine whether atypical antipsychotics initiated in the ICU at a large tertiary academic medical center were continued after hospital discharge. Safety outcomes were also assessed. Materials: A total of 1023 patients who received atypical antipsychotics during ICU stay were identified. Patients were assessed in a pseudo-randomized fashion until a sample of 191 patients was reached. After review of the exclusion criteria, the final study population was 100 patients. When antipsychotics were discontinued, progress notes were reviewed to identify the reason for discontinuation. Safety outcomes were assessed based on physician documentation in the medical charts. Results: Atypical antipsychotics were continued in 23% of patients. Atypical antipsychotics were discontinued in 1 patient due to QTc prolongation. Conclusions: Atypical antipsychotics initiated in the ICU are frequently continued after hospital discharge. Given the known risks associated with extended therapy, initiatives are needed to prevent inappropriate continuation.

scholarly journals A Qualitative Study of Physician Perspectives on Adaptation to Electronic Health Records

2019 ◽  
Author(s):  
Cynthia Judine Sieck ◽  
Nicole Pearl ◽  
Tiffani J. Bright ◽  
Po-Yin Yen
Keyword(s):  
Qualitative Study ◽  
Electronic Health Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Opportunity To Learn ◽  
Structured Interviews ◽  
Health Records ◽  
Physician Perspectives ◽  
Academic Medical ◽  
Electronic Health

Abstract Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation.Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 minutes, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis.Results We identified 4 major themes related to EHR adapation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adapation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaption.Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.

scholarly journals 307. Predictors of Respiratory Bacterial Co-Infection in Hospitalized COVID-19 Patients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S260-S260
Author(s):  
Erica E Reed ◽  
Austin Bolker ◽  
Kelci E Coe ◽  
Jessica M Smith ◽  
Kurt Stevenson ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Mortality Data ◽  
Chi Square ◽  
Academic Medical ◽  
Cumulative Duration ◽  
To Receive ◽  
Mlr Model

Abstract Background COVID-19 pneumonia can be indistinguishable from other infectious respiratory etiologies, so providers are challenged with deciding whether empiric antibiotics should be prescribed to hospitalized patients with SARS-CoV-2. This study aimed to evaluate predictors of respiratory bacterial co-infections (RBCI) in hospitalized patients with COVID-19. Methods Retrospective study evaluating COVID-19 inpatients from Feb 1, 2020 to Sept 30, 2020 at a tertiary academic medical center. Patients with RBCI were matched with three COVID-19 inpatients lacking RBCI admitted within 7 days of each other. The primary objectives of this study were to determine the prevalence of and identify variables associated with RBCI in COVID-19 inpatients. Secondary outcomes included length of stay and mortality. Data collected included demographics; inflammatory markers; bacterial culture/antigen results; antibiotic exposure; and COVID-19 severity. Wilcoxon rank sum, Chi Square tests, or Fisher’s exact tests were utilized as appropriate. A multivariable logistic regression (MLR) model was conducted to identify covariates associated with RBCI. Results Seven hundred thirty-five patients were hospitalized with COVID-19 during the study period. Of these, 82 (11.2%) had RBCI. Fifty-seven of these patients met inclusion criteria and were matched to three patients lacking RBCI (N = 228 patients). Patients with RBCI were more likely to receive antibiotics [57 (100%) vs. 130 (76%), p &lt; 0.0001] and for a longer cumulative duration [19 (13-33) vs. 8 (4-13) days, p &lt; 0.0001] compared to patients lacking RBCI. The MLR model revealed risk factors of RBCI to be admission from SNF/LTAC/NH (AOR 6.8, 95% CI 2.6-18.2), severe COVID-19 (AOR 3.03, 95% CI 0.78-11.9), and leukocytosis (AOR 3.03, 95% CI 0.99-1.16). Conclusion Although RBCI is rare in COVID-19 inpatients, antibiotic use is common. COVID-19 inpatients may be more likely to have RBCI if they are admitted from a SNF/LTAC/NH, have severe COVID-19, or present with leukocytosis. Early and prompt recognition of RBCI predictors in COVID-19 inpatients may facilitate timely antimicrobial therapy while improving antimicrobial stewardship among patients at low risk for co-infection. Disclosures All Authors: No reported disclosures

Gender differences in career progress and satisfaction in an academic medical center

2002 ◽  
Vol 2 (3) ◽  
pp. 95-104 ◽  
Author(s):  
JoAnn Manson ◽  
Beverly Rockhill ◽  
Margery Resnick ◽  
Eleanor Shore ◽  
Carol Nadelson ◽  
...  
Keyword(s):  
Gender Differences ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Career Progress
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