Medication reconciliation at hospital admission and discharge: insufficient knowledge, unclear task reallocation and lack of collaboration as major barriers to medication safety.
BACKGROUND
Medication errors are a leading cause of patient harm. Many of these errors result from an incomplete overview of medication either at a patient's referral to or at discharge from the hospital. One solution is medication reconciliation, a formal process in which health care professionals partner with patients to ensure an accurate and complete transfer of medication information at interfaces of care. In 2007, the Dutch government compelled hospitals to implement a bundle concerning medication reconciliation at hospital admission and discharge. But to date many hospitals have failed to implement this bundle fully. The aim of this study was to gain insight into the barriers and drivers of the implementation process.


METHODS
We performed face to face, semi-structured interviews with twenty health care professionals and managers from several departments at a 953 bed university hospital in the Netherlands and also from the surrounding community health services. The interviews were analysed using a combined theoretical framework of Grol and Cabana to classify the drivers and barriers identified.


RESULTS
There is lack of awareness and insufficient knowledge of health care professionals about the health care problem and the bundle medication reconciliation. These result in a lack of support for implementing the bundle. In addition clinicians are reluctant to reallocate tasks to nurses or pharmacy technicians. Another major barrier is a lack of communication, understanding and collaboration between hospital and community caregivers. The introduction of more competitive market forces has made matters worse. Major drivers are a good implementation plan, patient awareness, and obligation by the government.


CONCLUSIONS
We identified a wide range of barriers and drivers which health care professionals believe influence the implementation of medication reconciliation. This reflects the complexity of implementation. Implementation can be improved if these factors are adequately addressed. The feasibility and effectiveness of these strategies should be tested in controlled trails.
Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen, the Netherlands. n.vansluisveld@iq.umnc.nl
Nelleke
N
van Sluisveld
Marieke
M
Zegers
Stephanie
S
Natsch
Hub
H
Wollersheim
D003299:Cooperative Behavior; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology*; D008508:Medication Errors / Q000517:prevention & control*; D059065:Medication Reconciliation / Q000458:organization & administration*; D009426:Netherlands; D010343:Patient Admission; D010351:Patient Discharge; D036301:Qualitative Research