Making sense of diseases in medication reconciliation
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Patients are most at risk during transitions in care across settings and providers. The communication and reconciliation of an accurate medication list throughout the care continuum are essential in the reduction in transition-related adverse drug events. Most current research focuses on the outcomes of reconciliation interventions, yet not on the clinician’s perspective. We aimed to explore clinicians’ cognitive processes and heuristics of making sense of patients’ disease histories. We used the affinity diagram method to simulate real-life medication reconciliation with 24 clinicians. The participants were given paper cards with diseases and medications representing a real case from an anesthesiology department. The task was to sort the cards in a set that made sense to the clinician. The experiment was video-recorded, and the data were analyzed using a quantitative spatial analysis technique. Levene’s test for equality of variance showed that 79% of the 24 participants arranged the diseases along a straight line (p < 0.001). With only few exceptions, the diseases were arranged along the line in a fixed order, from cardiac conditions to depression (Friedman’s χ2(44) = 291.9, p < 0.001). We learn from this study that although clinicians employ a variety of coping strategies while reconciling patients’ medical histories, there are common reconciliation strategies. Understanding heuristics and the mental models clinicians have for the reconciliation process may help to develop and implement methods and tools to promote safety research and practice.
KeywordsMedication reconciliation Medical expertise Medical cognition Diagnostic reasoning Patient safety Card-sorting Affinity diagram
This work was kindly supported in part by a Fulbright doctoral dissertation research scholarship to Geva Vashitz. We would like to thank Christine Jette, MD and Annette Martini, MD, for their help in the experiment construction.
- Coffey M, Cornish P, Koonthanam T, Etchells E, Matlow A (2009) Implementation of admission medication reconciliation at two academic health sciences centres: challenges and success factors. Healthc Q 12 Spec No Patient:102–109Google Scholar
- JCAHO (2005) Joint commission on accreditation of healthcare organizations (JCAHO). 2005 hospital national patient safety goals. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/05_hap_npsgs.htm. Accessed 12 Apr 2010
- Poon EG, Blumenfeld B, Hamann C, Turchin A, Graydon-Baker E, McCarthy PC et al (2006) Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network. J Am Med Inform Assoc 13(6):581–592. doi: 10.1197/jamia.M2142 CrossRefGoogle Scholar
- Weingart SN, Cleary A, Seger A, Eng TK, Saadeh M, Gross A et al (2007) Medication reconciliation in ambulatory oncology. Jt Comm J Qual Patient Saf 33(12):750–757Google Scholar
- Wong JD, Bajcar JM, Wong GG, Alibhai SM, Huh JH, Cesta A et al (2008) Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother 42(10):1373–1379Google Scholar
- Woods DD (1993) Process-tracing methods for the study of cognition outside of the experimental psychology laboratory. Decision making in action: models and methods. Ablex Publishing, Westport, pp 228–251Google Scholar