Understanding Barriers and Solutions to Implementing Medication Reconciliation in Emergency Departments: A Qualitative Study

1University of California, San Francisco, San Francisco, CA
2Kaiser Permanente, San Rafael, CA
3Harvard, Boston, MA

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 68

Background:

Medication reconciliation is a process whereby medication lists are crosschecked and verified at significant points of contact with the health care system, so that a record of which medications are appropriately stopped, changed, or added is clear to caregivers and patients alike. Clinically meaningful medication reconciliation requires changes in work flow, organizational management, and substantial resources and has been difficult to achieve across health care settings, particularly in emergency departments, because of time constraints and overcrowding.

Methods:

This was a qualitative study based on semistructured interviews with emergency department clinicians, administrators, and staff at 3 hospitals (urban private academic teaching hospital, urban county hospital, suburban HMO hospital) from September 2009 to September 2010.

Results:

We have interviewed approximately 33 providers across all 3 sites (15 physicians, 15 nurses, 3 pharmacists). Providers expressed concern about spending a great deal of time interviewing patients to obtain and verify the accuracy of medications a patient is taking that may produce some overall benefit but a significant consequence in trade‐off costs to effectively manage other patients in the time‐sensitive setting of the emergency department. They commented on the need to design and develop more efficient, standardized systems and processes for obtaining medication histories using electronic medical records and other health information technology platforms, as their current systems were less than ideal (e.g., difficult or slow access to medical records, concerns about accuracy of data in medical records, minimal interoperability, new patient encounters). Empowering the patient to provide a current medication list in the emergency department (ED) was discussed as a highly desirable process to help improve assessment and evaluation by providers, although there were concerns about verifying the accuracy of the patient‐generated medication list.

Conclusions:

Providers in the ED face a number of challenges and barriers to effectively conducting medication reconciliation. A number of solutions involve defining standard procedures and roles, having improved computer systems and interoperability, and engaging the patient to improve communication.

Disclosures:

K. Lee ‐ none; D. Dohan ‐ none; D. Ballard ‐ none; J. Stein ‐ none; J. Hsu ‐ none

To cite this abstract:

Lee K, Dohan D, Ballard D, Stein J, Hsu J. Understanding Barriers and Solutions to Implementing Medication Reconciliation in Emergency Departments: A Qualitative Study. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 68. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/understanding-barriers-and-solutions-to-implementing-medication-reconciliation-in-emergency-departments-a-qualitative-study/. Accessed April 1, 2020.

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