title: Medication reconciliation: barriers and facilitators from the perspectives of resident physicians and pharmacists.
abstract: BACKGROUND
  Medication reconciliation can prevent medication errors and harm when patients transition between hospital and other care settings. Though a Joint Commission hospital Patient Safety Goal since 2006, organizations continue to have difficulty implementing the process.
  
  
  OBJECTIVE
  To determine factors that influence performance of medication reconciliation in a hospital setting with a computerized medication reconciliation tool.
  
  
  METHODS
  Cognitive task analysis (CTA) and focus group interviews.
  
  
  METHODS
  Urban, academic, tertiary-care Veterans Affairs medical center.
  
  
  METHODS
  Internal medicine house staff physicians (n = 23) and inpatient staff pharmacists (n = 12).
  
  
  METHODS
  CTA participants verbalized their thoughts while they completed medication reconciliation with the computerized tool. Focus group participants described medication reconciliation's purpose and effectiveness, how they completed the task, and its barriers and facilitators. Interviews were recorded and analyzed using social science methods for analyzing qualitative data.
  
  
  RESULTS
  Participants agreed that a central goal of medication reconciliation is to prevent prescribing errors, but disagreed about whether it achieves this goal. Computerization facilitated the task, but participants said that computers and patients can be unreliable sources of information. Participants varied in how they sequenced components of the task. When time was limited, physicians considered other responsibilities higher priority. Both physicians and pharmacists expressed low self-efficacy, ie, low perceived capability to achieve the objectives of the process.
  
  
  CONCLUSIONS
  Key barriers to medication reconciliation are unreliable sources of medication information and tasks that compete for providers' time and attention that they consider higher priority. Addressing these barriers while increasing providers' self-efficacy might improve medication reconciliation and its outcomes.
authors.affiliation: Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York 10468, USA. kenneth.boockvar@mssm.edu
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Boockvar
authors.forename: Susan L
authors.initials: SL
authors.lastname: Santos
authors.forename: Andre
authors.initials: A
authors.lastname: Kushniruk
authors.forename: Christopher
authors.initials: C
authors.lastname: Johnson
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Nebeker
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency; D007407:Interviews as Topic; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D059065:Medication Reconciliation / Q000706:statistics & numerical data*; D010595:Pharmacists / Q000523:psychology*; D010607:Pharmacy Service, Hospital; D010820:Physicians / Q000523:psychology*; D014584:User-Computer Interface