A Case Study of a Medication Reconciliation Process: The Health Care Providers’ Perspective
Jeffery, Cathy 1956-
Purpose: The purpose of this exploratory qualitative study was to gain a better understanding of health care professionals’ experiences and perspectives with the enactment of medication reconciliation, an intervention designed to promote safe, quality outcomes and continuity of care for patients who are transferred from urban acute care to urban long term care facilities. Research Design: Intrinsic Embedded Single Case Study Theoretical Framework: Normalization Process Theory and Extended Normalization Process Theory (General Theory of Implementation). Sample/Setting: The study sample included 10 health care providers (two registered nurses, six pharmacists, and two physicians) who completed at least one step of the medication reconciliation process for patients transferred from an urban acute care unit to an urban long term care facility in a large health region in Saskatchewan, Canada. Methods/Procedure: The data were collected using semi-structured interviews, which were digitally recorded and analyzed using thematic analysis to describe the medication reconciliation process from the study participants’ perspective. In addition, documents used in the medication reconciliation process in the health region of study were reviewed and consultations were held with key health region staff involved with the medication reconciliation process to add to the description of the process in regard to continuity of care and patient safety. Findings: There was overall consensus amongst the health care providers who participated in the study that medication reconciliation is an intervention that can improve medication safety and continuity of care in patient transitions through communication and the use of standardized forms. The study participants identified both benefits and challenges associated with the medication reconciliation process for patients transferred from urban acute care to urban long term care in the health region of study. Participants agreed that patients benefited from improved communication about medication prescribing and administration and the continuity of care this promoted. In addition, the participants felt that health care providers benefited from the efficiency of using standardized forms and from improved communication with other health care providers involved in the patient’s medication prescribing and administration. Major challenges identified by the study participants included lack of adequate notice of a patient transfer which increased the overall workload of hospital pharmacists. Acute care registered nurses in the health region of study were not involved in the medication reconciliation process for patients transferred to long term care, which could contribute to the increased workload experienced by hospital pharmacists. The timely acquisition of required physician signatures also provided a challenge. At the end of the data collection stage of the study, an initiative to allow for pharmacists to provide the final signature to the medication reconciliation forms was beginning to be implemented. This strategy may help to address some of the challenges associated with the medication reconciliation process. Conclusions: In general, the health care providers who participated in the study identified that the medication reconciliation process for patients transferred from urban acute care to urban long term facilities is an intervention that can facilitate safe medication prescribing and administration and continuity of care. Challenges with the process were health system driven. A focus on addressing timely notification of patient transfers, the use of alternate strategies to obtain required signatures, and maximizing the use of all health care providers to complete the medication reconciliation process may produce general improvements to this patient safety strategy. The findings of this study have implications for practice, further research, and the education of future health care professionals on the topic of mediation reconciliation as an intervention that can facilitate safe mediation prescribing and administration.
DegreeDoctor of Philosophy (Ph.D.)
CommitteeBerry, Lois; Domm, Elizabeth; Hellsten, Laurie; Bowen, Angela
Copyright DateOctober 2016
continuity of care