Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA.
College of Nursing and Health Professions, Drexel University, Philadelphia, PA.
J Am Med Dir Assoc. 2021 May;22(5):1003-1008. doi: 10.1016/j.jamda.2020.06.024. Epub 2020 Jul 25.
Characterize the work that home health care (HHC) admission nurses complete as part of the medication reconciliation tasks, explore the impact of shared electronic medication data (interoperability) from the referral source on medication reconciliation, and highlight opportunities to enhance medication reconciliation with respect to transition in care to HHC agencies.
Observational field study.
Three diverse Pennsylvania HHC agencies; each used different electronic health record systems with different interoperability characteristics. Six nurses per site admitted 2 patients each (36 patients total).
Researchers observed the admission process in the patient home and at the HHC agency. The nurses' tasks related to medication reconciliation were characterized by (1) number and change types (ie, medications dropped or added; changes to dose, frequency/administration time, or tablet types) made to the referrer medication list during and after the home visit, and (2) reasons that the nurse called the health provider (doctor, pharmacy) to resolve medication-related issues. Differences between interoperable and non-interoperable observations were explored.
Polypharmacy (on average, study patients were taking more than 12 medications) and high-risk medications (on average, more than 8 per patient) were pervasive. For 91% of patients, the number of medications decreased between pre- and post-reconciliation medication lists; 41% of the medications required changes. Nurses using interoperable systems needed to make fewer changes than nurses using non-interoperable systems. In two-thirds of observations, the nurse called a provider.
Changes to the referrer medication list and calls to providers highlighted the nurses' effort to complete the medication reconciliation. Interoperability appeared to reduce the number of changes required, but did not eliminate changes or calls to providers. We highlight opportunities to enhance medication reconciliation with respect to transition in care to HHC agencies.
描述家庭保健（HHC）入院护士在药物重整任务中完成的工作，探讨转诊来源的共享电子药物数据（互操作性）对药物重整的影响，并强调在向 HHC 机构过渡护理方面增强药物重整的机会。
观察性现场研究。
宾夕法尼亚州的三个不同的 HHC 机构；每个机构都使用不同的电子病历系统，具有不同的互操作性特征。每个地点的 6 名护士各收治 2 名患者（共 36 名患者）。
研究人员观察了患者家中和 HHC 机构的入院过程。护士在家庭访问期间和之后与药物重整相关的任务特征是：（1）在家庭访问期间和之后，对转诊者药物清单进行更改的数量和更改类型（即药物的删减或增加；剂量、频率/给药时间或片剂类型的更改）；（2）护士因解决药物相关问题而致电医疗保健提供者（医生、药房）的原因。探讨了互操作性和非互操作性观察之间的差异。
多药治疗（平均而言，研究患者服用的药物超过 12 种）和高危药物（平均每位患者超过 8 种）普遍存在。对于 91%的患者，预重整和后重整药物清单之间的药物数量减少；41%的药物需要更改。使用互操作系统的护士需要进行的更改比使用非互操作系统的护士少。在三分之二的观察中，护士致电提供者。
对转诊者药物清单的更改和致电提供者突出了护士完成药物重整的努力。互操作性似乎减少了所需的更改数量，但并未消除更改或致电提供者的情况。我们强调了在向 HHC 机构过渡护理方面增强药物重整的机会。
