Original Research
Medication reconciliation: A qualitative analysis of clinicians' perceptions

https://doi.org/10.1016/j.sapharm.2012.08.002Get rights and content

Abstract

Background

Medication reconciliation has been at the forefront of national patient safety efforts for nearly a decade, yet health care institutions remain challenged with implementation.

Objectives

The objective of this article was to report an analysis of a qualitative study of the experiences of physicians, nurses, and pharmacists with medication management practices, specifically focusing on the practice of medication reconciliation.

Methods

This study used focus groups in a qualitative approach to explore participant perceptions about interprofessional communication and adverse drug events. Three focus groups were conducted at each of 3 Veterans Administration hospitals, 1 each for physicians (13), nurses (19), and pharmacists (16). The analysis for this article focused on specific discussions about medication reconciliation.

Results

Two primary thematic questions emerged from the discussion about medication reconciliation: What does medication reconciliation really mean? Who is actually responsible for the process? Participants from each profession had differing perspectives about the purpose and processes of medication reconciliation. Perceived responsibilities appeared to be influenced by their distinct views regarding the meaning and purpose of medication reconciliation. The pharmacist role emerged as a critical role to assure medication safety.

Conclusions

Translating the intent of medication reconciliation into effective practice requires acknowledgment of the involved professionals' diverse perspectives on the independent, joint, and overlapping functions of medication management as well as recognizing the limitations of technology.

Section snippets

Background/rationale

Medication management is a prevalent and critical component of health care delivery and the most common source of error in health care.1, 2, 3 The adverse effects of medications have staggering economic consequences, and for elderly patients, adverse drug events (ADEs) are a leading cause of morbidity and mortality.4, 5 ADEs, defined as “harm resulting from the use of a drug,”3, 6, 7 are frequent in hospitalized patients, with estimates ranging from less than 3%8 to more than 32%.9 Hospitalized

Overview of the study

This qualitative study consisted of focus groups of physicians, nurses, and pharmacists conducted in 2008-2009 to gather data on interprofessional communication and ADEs at 3 Department of Veteran's Affairs Health Administration (VA) hospitals in the United States. Although there was no specific intent to target the distinct process of medication reconciliation in the study, the topic emerged frequently, both directly in reference to activities to prevent ADEs and implicitly related to shared

Results

Two major thematic questions consistently emerged from the focus group discussions about medication reconciliation: (1) What does medication reconciliation really mean? and (2) Who is actually responsible for the process? Each is discussed below in more detail.

Discussion

The 2 overarching themes of what does medication reconciliation really mean and who is actually responsible for the process are consistent with experts who suggest successfully minimizing medication errors at patient transitions requires a clearer definition of medication reconciliation and more clearly defined roles.30 However, this study moves beyond medication reconciliation as a means to minimize error30, 31 by suggesting that when considered in the larger process of medication management,

Conclusion

Medication reconciliation has been at the forefront of national patient safety efforts for nearly a decade, yet health care institutions remain challenged with implementation. Recognizing that medication reconciliation is an important process that impacts medication management and overall patient safety is important to gaining momentum toward successful translation into practice. Acknowledging the limitations of technology as well as the contribution of each clinical role in the process of

Acknowledgments

This project was funded by VA Health Services Research & Development NRI 05-275.

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