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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3043 — The Complexity of Interdisciplinary Communication for Medication Management

Weir CR, SLC VA GRECC and IDEAS; Kinney A, and Pepper G, University of Utah; Barrus R, SLC IDEAS Center; Sanders N, University of Utah;

Designers of information systems rarely recognize the degree of complexity, inter-dependency and cooperation required for effective medication management. The processes of medication management are “distributed” across roles, modes and settings, such that no one person has a complete and integrated view. The purpose of this study was to use focus group qualitative methodology to explore this domain more deeply in order to improve patient safety.

Three focus groups (one each of nurses, pharmacists and physicians) were conducted at 3 VA facilities selected to maximize diversity (13 physicians, 16 pharmacists, and 19 nurses). Stimulus questions and a vignette were used to elucidate responses. The goals in relation to medication management were: 1) assess clinician’s beliefs regarding the role of communication; 2) identify communication goals and role expectancies; 3) assess perceived organizational and technological barriers; and 4) explore differences in provider groups. The focus groups were audio-taped and transcribed. Qualitative analysis using ATLAS@ was conducted using iterative process of thematic identification.

Results: Five major themes emerged: 1) Getting the Big Picture is hard - The goals of care are not clear, there is a great deal of uncertainty regarding what the patient is actually taking, and the sources of information often conflict. 2) Lack of Common Ground – It is not clear who knows what about the patient and documentation of what has been done is inconsistent. Nurses “cover” for physicians in ways not acknowledged, and the pharmacist’s important consulting role is often hidden. 3) Diffusion of Responsibility – Some responsibilities for medication management are tossed like a “hot potato” from person to person, e.g. patient education, medication reconciliation. 4) Making it Work - Communication processes do not match workflow, resulting in multiple work-arounds. CPRS creates an aura of exactness that does not match reality. 5) Chaos and complexity - Participants referred to a constant aura of chaos. Patients are not sufficiently knowledgeable or involved.

Medication management communication is complex, imperfect and highly inter-dependent.

Future design of EHRs should include mechanisms to improve an integrated view of medication management information, including timing, source and responsibility in order to decrease ADEs.

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