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BACKGROUND/RATIONALE:
Patient transfer between sites of care is regular practice during an illness episode but is associated with care lapses, of which medication discrepancies and adverse drug events (ADEs) are among the most common. To improve medication safety for patients transferred between healthcare sites, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) made medication reconciliation a 2006 patient safety goal.
OBJECTIVE(S):
The objectives of this study are:
1) To conduct a controlled trial to evaluate the effectiveness of a CPRS medication reconciliation tool (JCAHO standard compliant) compared with usual care for veterans transferred between sites of care, with transition drug risk, transfer-related ADEs, provider prescribing decisions, and hospital use as outcomes;
2) To identify system and provider factors that impede and facilitate use of the tool;
3) To characterize providers' prescribing processes at the time of patient transfer and to identify residual unmet decision-support needs of providers caring for patients after patient transfer
METHODS:
This is a mixed quantitative and qualitative evaluation study. In the quantitative evaluation we will conduct an evaluation of the medication reconciliation tool compared with usual care among veterans admitted to the 2 general medical units at J.J. Peters (Bronx) VAMC between November 1, 2005 and January 31, 2006. Medication reconciliation will have been implemented in a unit-by-unit staggered fashion in anticipation of hospital-wide implementation by January 1, 2006 to comply with JCAHO standards. We will examine differences between intervention and control, and between 2 versions of implementation (physician- and pharmacist-initiated medication reconciliation), in transition drug risk as primary outcome, and occurrence of ADE, provider drug prescribing, and healthcare use as secondary outcomes. All measurements will be performed retrospectively by chart review. In the qualitative evaluation, we will record providers' actions and verbalized thoughts as they apply the tool to test cases, and perform focus group interviews with representative tool users to identify factors that facilitate or hinder use.
FINDINGS/RESULTS:
In individual "task analysis" interviews, there were 2 opposing approaches to conducting medication reconciliation. Approach 1, observed in some physicians, was characterized by scant information access and processing, little editing of note, completion times of 1 minute or less, and a belief that medication reconciliation is a requirement but not beneficial to providers or patients. Approach 2, observed in pharmacists and some physicians, was characterized by extensive information access and processing, editing of the note for readability, completion times of 5-15 minutes, and a belief that medication reconciliation is an important decision support process. Leading barriers to task completion were 1) high time burden, 2) low dialog readability, and 3) poor integration of the task into daily workflow.
IMPACT:
The proposed study will fill important gaps in knowledge about the effectiveness of a medication reconciliation support tool, and will inform efforts to further improve the process of drug prescribing during transfer in VA and non-VA settings.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Prevention, Communication and Decision Making, Technology Development and Assessment
Keywords:
Adverse events, Safety
MeSH Terms:
none
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