title: Naturalistic Usability Testing of Inpatient Medication Reconciliation Software.
abstract: Medication history errors are common at admission, but can be mitigated through the implementation of medication reconciliation (MR). We designed multi-media software to assist clinicians with collection of an admission history. This manuscript describes a naturalistic usability study conducted on the hospital wards. Our goals were to 1) estimate the impact of our workflow upon departmental productivity and 2) determine the ability of our software to detect discrepancies. We furnished clinical pharmacists with our application on a tablet PC and asked them to collect a bedside history. We used 1) time-motion analysis to estimate cycle-time and 2) chart reviews to estimate error detection rates. Our intervention detected an average of 7.7 discrepancies per admission (11.7 per pharmacy-shift). A panel rated 67% of these discrepancies as 'high' or 'very high' risk. The cycle-time per admission was slightly longer than usual care processes (20.5 min vs. 17.9 min), but included a bedside interview. In general, pharmacists agreed that the technology improved the completeness and accuracy of a medication history. However, workflow leveling strategies are important to implementing a durable process. In conclusion, a pharmacist-mediated, patient-centered technology holds promise for improving the quality of MR and overall clinical performance.
authors.affiliation: NorthWest Innovation Center, VA Portland Healthcare System, United States.
authors.forename: Blake
authors.initials: B
authors.lastname: Lesselroth
authors.affiliation: NorthWest Innovation Center, VA Portland Healthcare System, United States.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Adams
authors.affiliation: NorthWest Innovation Center, VA Portland Healthcare System, United States.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Tallett
authors.affiliation: NorthWest Innovation Center, VA Portland Healthcare System, United States.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Ong
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, United States.
authors.forename: Susan
authors.initials: S
authors.lastname: Bliss
authors.affiliation: NorthWest Innovation Center, VA Portland Healthcare System, United States.
authors.forename: Scott
authors.initials: S
authors.lastname: Ragland
authors.affiliation: NorthWest Innovation Center, VA Portland Healthcare System, United States.
authors.forename: Hanna
authors.initials: H
authors.lastname: Tran
authors.affiliation: NorthWest Innovation Center, VA Portland Healthcare System, United States.
authors.forename: Victoria
authors.initials: V
authors.lastname: Church
mesh_terms: D034201:Computers, Handheld / Q000706:statistics & numerical data; D006787:Hospitals, Veterans; D006801:Humans; D007297:Inpatients; D008508:Medication Errors / Q000517:prevention & control; D059065:Medication Reconciliation / Q000379:methods*; D063731:Mobile Applications; D010343:Patient Admission; D010595:Pharmacists; D057188:Workflow
keywords: electronic health records; human factors; medication reconciliation; patient safety; sociotechnical; usability engineering; usability inspection