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Leon C, Hogan H, Jani YH. Identifying and mapping measures of medication safety during transfer of care in a digital era: a scoping literature review. BMJ Qual Saf 2024; 33:173-186. [PMID: 37923372 PMCID: PMC10894843 DOI: 10.1136/bmjqs-2022-015859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Measures to evaluate high-risk medication safety during transfers of care should span different safety dimensions across all components of these transfers and reflect outcomes and opportunities for proactive safety management. OBJECTIVES To scope measures currently used to evaluate safety interventions targeting insulin, anticoagulants and other high-risk medications during transfers of care and evaluate their comprehensiveness as a portfolio. METHODS Embase, Medline, Cochrane and CINAHL databases were searched using scoping methodology for studies evaluating the safety of insulin, anticoagulants and other high-risk medications during transfer of care. Measures identified were extracted into a spreadsheet, collated and mapped against three frameworks: (1) 'Key Components of an Ideal Transfer of Care', (2) work systems, processes and outcomes and (3) whether measures captured past harms, events in real time or areas of concern. The potential for digital health systems to support proactive measures was explored. RESULTS Thirty-five studies were reviewed with 162 measures in use. Once collated, 29 discrete categories of measures were identified. Most were outcome measures such as adverse events. Process measures included communication and issue identification and resolution. Clinic enrolment was the only work system measure. Twenty-four measures captured past harm (eg, adverse events) and six indicated future risk (eg, patient feedback for organisations). Two real-time measures alerted healthcare professionals to risks using digital systems. No measures were of advance care planning or enlisting support. CONCLUSION The measures identified are insufficient for a comprehensive portfolio to assess safety of key medications during transfer of care. Further measures are required to reflect all components of transfers of care and capture the work system factors contributing to outcomes in order to support proactive intervention to reduce unwanted variation and prevent adverse outcomes. Advances in digital technology and its employment within integrated care provide opportunities for the development of such measures.
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Affiliation(s)
- Catherine Leon
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Yogini H Jani
- Department of Practice and Policy, University College London School of Pharmacy, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
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2
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Ngo NUT, Tangpraphaphorn S, Kahaku D, Canamar CP, Young A. Clinical Pharmacist Transition of Care Model Improves Hospital System Practice by Reducing Readmissions. J Healthc Qual 2023; 45:272-279. [PMID: 37039811 DOI: 10.1097/jhq.0000000000000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
PURPOSE A primary cause of hospital readmission is medication-related problems (MRPs). Polypharmacy patients taking multiple medications concurrently experience an increased likelihood of MRPs and high occurrence of readmissions to the hospital within 30 days. This study assessed the ability of a pharmacist-led transition of care program to decrease readmissions in polypharmacy patients by evaluating and rectifying MRPs. METHODS Over 16 months, patients admitted onto the medicine ward service with ≥10 home medications ( n = 536) received medication management interventions from a clinical pharmacist including admission interview, medication reconciliation and consultation, and postdischarge phone follow-up. Admitted patients taking fewer than 10 home medications during the same time served as the control group and received routine standard of care ( n = 2317). RESULTS The polypharmacy group who received the pharmacist-led intervention had a statistically significantly lower 30-day readmission rate (8.8%) compared with patients in the control group (12.4%; X 2 = 5.63, p = .01). Patients receiving pharmacist intervention were 33% less likely to be readmitted within 30 days of discharge compared with the control group (odds ratio = 0.67, 95% CI = 0.49-0.94). All patients had at least one medication-related discrepancy. CONCLUSION This pharmacy-led transition of care program can effectively reduce readmission rates through resolution of medication-related problems.
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3
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Xiao Y, Miller K, Werner N, Smith K, Hendrix N, Hemmelgarn C. Co-Design with Patients for Improving Patient Safety: Strategies, Barriers and pitfalls. PROCEEDINGS OF THE HUMAN FACTORS AND ERGONOMICS SOCIETY ... ANNUAL MEETING. HUMAN FACTORS AND ERGONOMICS SOCIETY. ANNUAL MEETING 2023; 67:633-638. [PMID: 38213999 PMCID: PMC10782182 DOI: 10.1177/21695067231192416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
What happens when "frontline" workers are patients and family members performing health-related tasks? As more and more complex healthcare tasks are performed by patients and family members, and more emphasis is placed on patient- and family-centered care, strategies are needed to engage patients and family members in co-design "work systems" and patient-professional collaborative work. Human factors professionals are well-equipped to apply participatory ergonomics to patient and collaborative tasks. However, there are a number of barriers and pitfalls in engaging patients in design. Moving from tokenism to meaningful engagement in research requires patience, constant reflection, and a commitment to codesign. Our panel will explore the continuum of engagement and strategies to move from tokenism to partnership to cocreation in patient safety research, ranging from ambulatory medication safety to diagnosis in the emergency department. Strategies and barriers are presented as a starting point to discuss how to achieve effective work system designs.
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Affiliation(s)
- Yan Xiao
- University of Texas at Arlington,
Arlington, Texas, USA
| | - Kristen Miller
- MedStar Health and Georgetown
University, Washington, DC, USA
| | - Nicole Werner
- Indiana University Bloomington,
Bloomington, Indiana, USA
| | | | - Noah Hendrix
- University of Texas at Arlington,
Arlington, Texas, USA
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4
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Young RA, Gurses AP, Fulda KG, Espinoza A, Daniel KM, Hendrix ZN, Sutcliffe KM, Xiao Y. Primary care teams' reported actions to improve medication safety: a qualitative study with insights in high reliability organising. BMJ Open Qual 2023; 12:e002350. [PMID: 37777254 PMCID: PMC10546137 DOI: 10.1136/bmjoq-2023-002350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/11/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Our aim was to understand actions by primary care teams to improve medication safety. METHODS This was a qualitative study using one-on-one, semistructured interviews with the questions guided by concepts from collaborative care and systems engineering models, and with references to the care of older adults. We interviewed 21 primary care physicians and their team members at four primary care sites serving patients with mostly low socioeconomic status in Southwest US during 2019-2020. We used thematic analysis with a combination of inductive and deductive coding. First, codes capturing safety actions were incrementally developed and revised iteratively by a team of multidisciplinary analysts using the inductive approach. Themes that emerged from the coded safety actions taken by primary care professionals to improve medication safety were then mapped to key principles from the high reliability organisation framework using a deductive approach. RESULTS Primary care teams described their actions in medication safety mainly in making standard-of-care medical decisions, patient-shared decision-making, educating patients and their caregivers, providing asynchronous care separate from office visits and providing clinical infrastructure. Most of the actions required customisation at the individual level, such as limiting the supply of certain medications prescribed and simplifying medication regimens in certain patients. Primary care teams enacted high reliability organisation principles by anticipating and mitigating risks and taking actions to build resilience in patient work systems. The primary care teams' actions reflected their safety organising efforts as responses to many other agents in multiple settings that they could not control nor easily coordinate. CONCLUSIONS Primary care teams take many actions to shape medication safety outcomes in community settings, and these actions demonstrated that primary care teams are a reservoir of resilience for medication safety in the overall healthcare system. To improve medication safety, primary care work systems require different strategies than those often used in more self-contained systems such as hospital inpatient or surgical services.
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Affiliation(s)
| | - Ayse P Gurses
- Johns Hopkins University Medical School, Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA
| | - Kimberly G Fulda
- Family Medicine and Osteopathic Manipulative Medicine, UNTHSC, Fort Worth, Texas, USA
| | - Anna Espinoza
- Family Medicine and Osteopathic Manipulative Medicine, UNTHSC, Fort Worth, Texas, USA
| | - Kathryn M Daniel
- College of Nursing and Health Innovation, UT Arlington, Arlington, Texas, USA
| | - Zachary N Hendrix
- College of Nursing and Health Innovation, UT Arlington, Arlington, Texas, USA
| | | | - Yan Xiao
- College of Nursing and Health Innovation, UT Arlington, Arlington, Texas, USA
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5
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Chen KY, Lang Y, Zhou Y, Kosmari L, Daniel K, Gurses A, Xiao Y. Assessing Interventions on Crowdsourcing Platforms to Nudge Patients for Engagement Behaviors in Primary Care Settings: Randomized Controlled Trial. J Med Internet Res 2023; 25:e41431. [PMID: 37440308 PMCID: PMC10375278 DOI: 10.2196/41431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Engaging patients in health behaviors is critical for better outcomes, yet many patient partnership behaviors are not widely adopted. Behavioral economics-based interventions offer potential solutions, but it is challenging to assess the time and cost needed for different options. Crowdsourcing platforms can efficiently and rapidly assess the efficacy of such interventions, but it is unclear if web-based participants respond to simulated incentives in the same way as they would to actual incentives. OBJECTIVE The goals of this study were (1) to assess the feasibility of using crowdsourced surveys to evaluate behavioral economics interventions for patient partnerships by examining whether web-based participants responded to simulated incentives in the same way they would have responded to actual incentives, and (2) to assess the impact of 2 behavioral economics-based intervention designs, psychological rewards and loss of framing, on simulated medication reconciliation behaviors in a simulated primary care setting. METHODS We conducted a randomized controlled trial using a between-subject design on a crowdsourcing platform (Amazon Mechanical Turk) to evaluate the effectiveness of behavioral interventions designed to improve medication adherence in primary care visits. The study included a control group that represented the participants' baseline behavior and 3 simulated interventions, namely monetary compensation, a status effect as a psychological reward, and a loss frame as a modification of the status effect. Participants' willingness to bring medicines to a primary care visit was measured on a 5-point Likert scale. A reverse-coding question was included to ensure response intentionality. RESULTS A total of 569 study participants were recruited. There were 132 in the baseline group, 187 in the monetary compensation group, 149 in the psychological reward group, and 101 in the loss frame group. All 3 nudge interventions increased participants' willingness to bring medicines significantly when compared to the baseline scenario. The monetary compensation intervention caused an increase of 17.51% (P<.001), psychological rewards on status increased willingness by 11.85% (P<.001), and a loss frame on psychological rewards increased willingness by 24.35% (P<.001). Responses to the reverse-coding question were consistent with the willingness questions. CONCLUSIONS In primary care, bringing medications to office visits is a frequently advocated patient partnership behavior that is nonetheless not widely adopted. Crowdsourcing platforms such as Amazon Mechanical Turk support efforts to efficiently and rapidly reach large groups of individuals to assess the efficacy of behavioral interventions. We found that crowdsourced survey-based experiments with simulated incentives can produce valid simulated behavioral responses. The use of psychological status design, particularly with a loss framing approach, can effectively enhance patient engagement in primary care. These results support the use of crowdsourcing platforms to augment and complement traditional approaches to learning about behavioral economics for patient engagement.
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Affiliation(s)
- Kay-Yut Chen
- College of Business, University of Texas at Arlington, Arlington, TX, United States
| | - Yan Lang
- Department of Business, State University of New York at Oneonta, Oneonta, NY, United States
| | - Yuan Zhou
- Department of Industrial, Manufacturing, and Systems Engineering, University of Texas at Arlington, Arlington, TX, United States
| | - Ludmila Kosmari
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Kathryn Daniel
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Ayse Gurses
- Armstrong Institute Center for Health Care Human Factors, Anesthesiology and Critical Care, Emergency Medicine, and Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Yan Xiao
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
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6
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Xiao Y, Smith A, Abebe E, Hannum SM, Wessell AM, Gurses AP. Understanding Hazards for Adverse Drug Events Among Older Adults After Hospital Discharge: Insights From Frontline Care Professionals. J Patient Saf 2022; 18:e1174-e1180. [PMID: 35617608 PMCID: PMC9679039 DOI: 10.1097/pts.0000000000001046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Care transitions pose a high risk of adverse drug events (ADEs). We aimed to identify hazards to medication safety for older adults during care transitions using a systems approach. METHODS Hospital-based professionals from 4 hospitals were interviewed about ADE risks after hospital discharge among older adults. Concerns were extracted from the interview transcript, and for each concern, hazard for medication-related harms was coded and grouped by its sources according to a human factors and systems engineering model that views postdischarge ADEs as the outcome of professional and patient home work systems. RESULTS Thirty-eight professionals participated (5 hospitalists, 24 nurses, 4 clinical pharmacists, 3 pharmacy technicians, and 2 social workers). Hazards were classified into 6 groups, ranked by frequencies of hazards coded: (1) medication tasks related at home, (2) patient and caregiver related, (3) hospital work system related, (4) home resource related, (5) hospital professional-patient collaborative work related, and (6) external environment related. Medications most frequently cited when describing concerns included anticoagulants, insulins, and diuretics. Top coded hazard types were complex dosing, patient and caregiver knowledge gaps in medication management, errors in discharge medications, unaffordable cost, inadequate understanding about changes in medications, and gaps in access to care or in sharing medication information. CONCLUSIONS From the perspective of hospital-based frontline health care professionals, hazards for medication-related harms during care transitions were multifactorial and represented those introduced by the hospital work system as well as defects unrecognized and unaddressed in the home work system.
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Affiliation(s)
- Yan Xiao
- From the College of Nursing and Health Innovation, University of Texas at Arlington
| | - Aaliyah Smith
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Ephrem Abebe
- Department of Pharmacy Practice, Purdue University, College of Pharmacy, West Lafayette, Indiana
| | - Susan M Hannum
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrea M Wessell
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Ayse P Gurses
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, Maryland
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7
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Sharara SL, Arbaje AI, Cosgrove SE, Gurses AP, Dzintars K, Ladikos N, Qasba SS, Keller SC. The Voice of the Patient: Patient Roles in Antibiotic Management at the Hospital-to-Home Transition. J Patient Saf 2022; 18:e633-e639. [PMID: 34569996 PMCID: PMC8940725 DOI: 10.1097/pts.0000000000000899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our objective was to characterize tasks required for patient-performed antibiotic medication management (MM) at the hospital-to-home transition, as well as barriers to and strategies for patient-led antibiotic MM. Our overall goal was to understand patients' role in managing antibiotics at the hospital-to-home transition. METHODS We performed a qualitative study including semistructured interviews with health care workers and contextual inquiry with patients discharged home on oral antibiotics. The setting was one academic medical center and one community hospital. Participants included 37 health care workers and 16 patients. We coded interview transcripts and notes from contextual inquiry and developed themes. RESULTS We identified 6 themes involving barriers or strategies for antibiotic MM. We identified dissonance between participant descriptions of the ease of antibiotic MM at the hospital-to-home transition and their experience of barriers. Similarly, patients did not always recognize when they were experiencing side effects. Lack of access to follow-up care led to unnecessarily long antibiotic courses. Instructions about completing antibiotics were not routinely provided. However, patients typically did not question the need for the prescribed antibiotic. CONCLUSIONS There are many opportunities to improve patient-led antibiotic MM at the hospital-to-home transition. Mismatches between patient perceptions and patient experiences around antibiotic MM at the hospital-to-home transition provide opportunities for health system improvement.
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Affiliation(s)
- Sima L Sharara
- From the Division of Infectious Diseases, Department of Medicine
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8
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Sharara SL, Arbaje AI, Cosgrove SE, Gurses AP, Dzintars K, Keller SC. Medications at discharge aren't just for the long haul: A model for the management of short-term medications. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211065853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sima L. Sharara
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alicia I. Arbaje
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Sara E. Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ayse P. Gurses
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Whiting School of Engineering, Baltimore, Maryland
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Sara C. Keller
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
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9
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Carman EM, Fray M, Waterson P. Facilitators and barriers of care transitions - Comparing the perspectives of hospital and community healthcare staff. APPLIED ERGONOMICS 2021; 93:103339. [PMID: 33611077 DOI: 10.1016/j.apergo.2020.103339] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/14/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
As a patient moves from hospital back home to receive community-based care, quality of care and patient safety are often put at risk. This study aimed to analyse the discharge process to identify and compare the barriers and facilitators within the context of the system in which they occur, from the perspectives of both hospital and community healthcare staff. The results were derived from the analysis of 348 incident reports, the observation of five discharge planning meetings with hospital staff, three focus groups with hospital staff, and six focus groups with community healthcare staff. Five themes representative of the barriers and four themes representative of the facilitators for this process were identified from both hospital and community healthcare staff's perspective. These were then discussed in the context of the subsystem, hospital or community healthcare setting, in which they occur.
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Affiliation(s)
- Eva-Maria Carman
- Human Factors and Complex Systems Group, School of Design and Creative Arts, Loughborough University, Loughborough, UK; Trent Simulation and Clinical Skills Centre, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Michael Fray
- Environmental Ergonomics Research Centre, School of Design and Creative Arts, Loughborough University, Loughborough, UK
| | - Patrick Waterson
- Human Factors and Complex Systems Group, School of Design and Creative Arts, Loughborough University, Loughborough, UK
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10
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Hannum SM, Abebe E, Xiao Y, Brown R, Peña IM, Gurses AP. Engineering care transitions: Clinician perceptions of barriers to safe medication management during transitions of patient care. APPLIED ERGONOMICS 2021; 91:103299. [PMID: 33161183 PMCID: PMC10416651 DOI: 10.1016/j.apergo.2020.103299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 06/11/2023]
Abstract
Medication safety during care transitions is a significant challenge, especially for older adults prescribed multiple medications. Using a systems approach to understand barriers to and strategies for safe medication management throughout high-risk periods of hospital-to-home transition is one important step in designing effective interventions. Framing the care transition as a collaboration between healthcare and patient "work systems," we conducted semi-structured interviews with 37 clinical team members, representing 10 different professional roles involved in providing transitional care for patients. Thematic analyses identified key strategies used by clinical team members in preparing patients to self-manage medications safely in the home environment: (1) streamlining and coordinating clinical management of medication reconciliation across care settings; (2) building patient capacity and engagement in self-management of medications; and (3) redesigning the transitional process. Our research highlights the value in aligning professionals' care transition goals with patients and caregiver(s) to better prepare them to self-manage medications upon discharge.
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Affiliation(s)
- S M Hannum
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Rm. 727, Baltimore, MD, 21205, USA.
| | - E Abebe
- Purdue University,College of Pharmacy, Department of Pharmacy Practice, West Lafayette, IN, USA
| | - Y Xiao
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, TX, USA
| | - R Brown
- UChicago Medicine, Department of Quality Process Improvement, Chicago, IL, USA
| | - I M Peña
- Johns Hopkins Bayview Medical Center, Department of Internal Medicine, Baltimore, MD, USA
| | - A P Gurses
- Johns Hopkins School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
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11
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Holden RJ, Abebe E. Medication transitions: Vulnerable periods of change in need of human factors and ergonomics. APPLIED ERGONOMICS 2021; 90:103279. [PMID: 33049545 PMCID: PMC7606579 DOI: 10.1016/j.apergo.2020.103279] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 06/06/2023]
Abstract
We present a novel view of transitions from the lens of patient ergonomics (the "science of patient work"), which posits that patients and other non-professionals perform effortful work towards health-related goals. In patient work transitions, patients experience changes in, for example, health, task demands, work capacity, roles and responsibilities, knowledge and skills, routines, needs and technologies. Medication transitions are a particularly vulnerable type of patient work transitions. We describe two cases of medication transitions-new medications and medication deprescribing-in which the patient work lens reveals many accompanying changes, vulnerabilities, and opportunities for human factors and ergonomics.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Ephrem Abebe
- Purdue University College of Pharmacy, West Lafayette, IN, USA
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12
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Keller SC, Cosgrove SE, Arbaje AI, Chang RHE, Krosche A, Williams D, Gurses AP. Roles and Role Ambiguity in Patient- and Caregiver-Performed Outpatient Parenteral Antimicrobial Therapy. Jt Comm J Qual Patient Saf 2019; 45:763-771. [PMID: 31447376 PMCID: PMC6823133 DOI: 10.1016/j.jcjq.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Complicated medical therapies traditionally performed in acute care hospitals are increasingly moving to the home, requiring patients and informal caregivers to perform complicated medical tasks. For example, in outpatient parenteral antimicrobial therapy (OPAT), patients and caregivers perform antimicrobial infusions and venous catheter care. The objective of this study was to characterize patient understanding of patient, caregiver, and health care worker roles in OPAT and barriers to fulfilling these roles, with the goal of understanding how to best support patients and their caregivers. METHODS A qualitative study using 40 semistructured telephone interviews and 20 contextual inquiries of patients and caregivers performing OPAT tasks was performed. Eligible participants were discharged from two academic medical centers on OPAT. Interview transcripts and notes from contextual inquiry were coded based on a human factors engineering model. RESULTS Four main roles are described: communicator, advocate, learner-trainer, and lay health care worker doing "high-skilled tasks." Patients and caregivers experienced role ambiguity about OPAT task performance at the time of hospital discharge. Patients noted that their health care workers experienced role ambiguity as well, particularly regarding who was managing their care. Patients and caregivers used role transitions to achieve workload management, in which patients and caregivers transitioned OPAT tasks or non-OPAT tasks from one person to another. CONCLUSION Clear delineation of roles in complicated home-based medical therapies and training of all who may perform these tasks could improve the safety and quality of home-based care.
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Affiliation(s)
- Sara C. Keller
- Division of Infectious Diseases, Department of Medicine; Associate Faculty, Armstrong Institute for Patient Safety and Quality, Anesthesiology and Critical Care Medicine; Johns Hopkins University School of Medicine, Baltimore
| | - Sara E. Cosgrove
- Division of Infectious Diseases, Department of Medicine; Faculty, Armstrong Institute for Patient Safety and Quality, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Alicia I. Arbaje
- Medicine, Director of Transitional Care Research, Center for Transformative Geriatrics Research, Division of Geriatric Medicine and Gerontology, Department of Medicine; Johns Hopkins University School of Medicine, and Faculty, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | | | - Amanda Krosche
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine
| | - Deborah Williams
- Division of Quality Management, Johns Hopkins Home Care Group, Baltimore
| | - Ayse P. Gurses
- Armstrong Institute for Patient Safety and Quality, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine; Associate Professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
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13
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Scott J, Heavey E, Waring J, De Brún A, Dawson P. Implementing a survey for patients to provide safety experience feedback following a care transition: a feasibility study. BMC Health Serv Res 2019; 19:613. [PMID: 31470853 PMCID: PMC6716906 DOI: 10.1186/s12913-019-4447-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background The aim was to determine the feasibility of implementing a patient safety survey which measures patients’ experiences of their own safety relating to a care transition. This included limited-efficacy testing, determining acceptability (to patients and staff), and investigating integration with existing systems and practices from the staff perspective. Methods Mixed methods study in 16 wards across four hospitals, from two English NHS Trusts and four clinical areas; cardiology, care of older people, orthopaedics, stroke. Limited-efficacy testing of a previously validated survey was conducted through collection of patient reports of safety experiences, and thematic comparison with staff safety incident reports. Patient acceptability was determined through analysis of survey response rates and semi-structured interviews. Staff acceptability and integration were investigated through analysis of survey distribution rates, semi-structured interviews and focus groups. Results Patients returned 366 valid surveys (16.4% response rate) from 2824 distributed surveys (25.1% distribution rate). Older age was a contributing factor to lower responses. Delays were the largest safety concern for patients. Staff incident report themes included five not present in the safety survey data (documentation, pressure ulcers, devices or equipment, staffing shortages, and patient actions). Patient interviews (n = 28) identified that providing feedback was acceptable, subject to certain conditions being met; cognitive-cultural (patient understanding and prioritisation of safety), structural-procedural (opportunities, means and ease of providing feedback without fear of reprisals), and learning and change (closure of the feedback loop). Staff (n = 21) valued patient feedback but barriers to collecting and using the feedback included resource limitations, staff turnover and reluctance to over-burden patients. Conclusions Patients can provide meaningful feedback on their experiences and perceptions of safety in the context of care transitions. Providing this feedback was acceptable to some patients, subject to certain conditions being met. Safety experience feedback from patients was also acceptable to staff; quantitative data was perceived as useful to identify potential risks, and qualitative data informed types of changes required to improve care. However, patient feedback was not integrated into any quality improvement initiatives, suggesting there are still significant challenges to healthcare teams or organisations utilising patient feedback, particularly in relation to care transitions. Electronic supplementary material The online version of this article (10.1186/s12913-019-4447-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jason Scott
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
| | - Emily Heavey
- Department of Behavioural and Social Sciences, University of Huddersfield, Huddersfield, UK
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Pamela Dawson
- PD Education and Health Consulting Ltd, Newcastle upon Tyne, UK
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