Implementation strategies in the context of medication reconciliation: a qualitative study

Abstract

Background Medication reconciliation (MedRec) is an important patient safety initiative that aims to prevent patient harm from medication errors. Yet, the implementation and sustainability of MedRec interventions have been challenging due to contextual barriers like the lack of interprofessional communication (among pharmacists, nurses, and providers) and limited organizational capacity. How to best implement MedRec interventions remains unclear. Guided by the Expert Recommendations for Implementing Change (ERIC) taxonomy, we report the differing strategies hospital implementation teams used to implement an evidence-based MedRec Toolkit (the MARQUIS Toolkit). Methods A qualitative study was conducted with implementation teams and executive leaders of hospitals participating in the federally funded “Implementation of a Medication Reconciliation Toolkit to Improve Patient Safety” (known as MARQUIS2) research study. Data consisted of transcripts from web-based focus groups and individual interviews, as well as meeting minutes. Interview data were transcribed and analyzed using content analysis and the constant comparison technique. Results Data were collected from 16 hospitals using 2 focus groups, 3 group interviews, and 11 individual interviews, 10 sites’ meeting minutes, and an email interview of an executive. Major categories of implementation strategies predominantly mirrored the ERIC strategies of “Plan,” “Educate,” “Restructure,” and “Quality Management.” Participants rarely used the ERIC strategies of finance and attending to policy context. Two new non-ERIC categories of strategies emerged—“Integration” and “Professional roles and responsibilities.” Of the 73 specific strategies in the ERIC taxonomy, 32 were used to implement the MARQUIS Toolkit and 11 new, and non-ERIC strategies were identified (e.g., aligning with existing initiatives and professional roles and responsibilities). Conclusions Complex interventions like the MARQUIS MedRec Toolkit can benefit from the ERIC taxonomy, but adaptations and new strategies (and even categories) are necessary to fully capture the range of approaches to implementation.

Differences in medication reconciliation interventions between six hospitals: a mixed method study

“…Apart from aforementioned obstacles and high risk patient population (elderly with or without polypharmacy), other factors like socioeconomic status and process-related factors have not been mentioned or investigated in previous studies. Even the recently published qualitative study among several US based hospitals was not conclusive on how MedRec should be implemented [ 31 ]. Therefore, our results give new insight in facilitators and barriers to perform MedRec activities within hospitals.…”

Differences in stakeholder-reported barriers and implementation strategies between counties with high, middle, and low HPV vaccine initiation rates: a mixed methods study

“…Our application of the ERIC framework to the qualitative interviews from stakeholders strengthens and expands the use of the ERIC framework as a strategy to evaluate the differences in implementation strategies between the high- and low-performing groups. The ERIC strategy has been used to quantitively divide the strategies reported in the focus groups [ 42 ]. One study compared the ERIC strategies between sites by providing a list of ERIC strategies and asking sites to endorse strategies they use [ 43 ].…”

Impact of pharmacist‐initiated educational interventions on improving medication reconciliation practice in geriatric inpatients during hospital admission in Vietnam

“…With all the aforementioned constraints, the medication reconciliation interventions applied in this study were chosen to ensure the long‐term feasibility of implementation and effectiveness of the interventions in the context of Vietnam 23 . As a result, providing physicians with brief education to raise their knowledge of the problem as well as a short conventional training session may be the most appropriate method 15 . Our study showed that pharmacist‐led educational interventions are clinically effective by reducing the number of UMDs (including major UMDs), and are an approach that does not require significant modifications to the current healthcare system in nations with low human resources, such as Vietnam.…”

“…Hence, it would be prudent to find the most effective approach to utilizing pharmacists for this activity, with minimal disruption to their current clinical practice. We proposed that the provision of a short educational programme tailored for physicians may be the most appropriate approach to increase their awareness of the problem as well as to provide some training in medication reconciliation 15 …”

“…We proposed that the provision of a short educational programme tailored for physicians may be the most appropriate approach to increase their awareness of the problem as well as to provide some training in medication reconciliation. 15 The main aim of the study was to determine the effect of Currently, there are no mandatory regulatory requirements or standard professional practice guidelines. In practice, healthcare staff (i.e., physicians or nurses) would normally take the medication history of patients during clinical examination and record this in the patients' medical record (paper-based medical record) without a SOP.…”