Department of Medical Informatics, The University of Oklahoma-Tulsa, Tulsa, Oklahoma, USA
School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada.
BMJ Open Qual. 2022 Oct;11(4). doi: 10.1136/bmjoq-2021-001750.
Medication reconciliation (MR) can detect medication history discrepancies at interfaces-in-care and help avoid downstream adverse drug events. However, organisations have struggled to implement high-quality MR programmes. The literature has identified systems barriers, including technology capabilities and data interoperability. However, organisational culture as a root cause has been underexplored.
Our objectives were to develop an implementation readiness questionnaire and measure staff attitudes towards MR across a healthcare enterprise.
We developed and distributed a questionnaire to 170 Veterans' Health Affairs (VHA) sites using Research Electronic Data Capture (REDCap) software. The questionnaire contained 21 Likert-scale items that measured three constructs, such as: (1) the extent that clinicians valued MR; (2) perceptions of workflow compatibility and (3) perceptions concerning organisational climate of implementation.
8704 clinicians and staff responded to our questionnaire (142 of 170 VHA facilities). Most staff believed reconciling medications can improve medication safety (approximately 90% agreed it was 'important'). However, most (approximately 90%) also expressed concerns about changes to their workflow. One-third of respondents prioritised other duties over MR and reported barriers associated with implementation climate. Only 47% of respondents agreed they had enough resources to address discrepancies when identified.
Our findings indicate that an MR readiness assessment can forecast challenges and inform development of a context-sensitive implementation bundle. Clinicians surveyed struggled with resources, technology challenges and implementation climate. A strong campaign should include clear leadership messaging, credible champions and resources to overcome technical challenges.
This manuscript provides a method to conduct a readiness assessment and highlights the importance of organisational culture in an MR campaign. The data can help assess site or network readiness for an MR change management programme.
药物重整（MR）可以检测医疗护理交接点的用药史差异，有助于避免下游药物不良事件。然而，各组织在实施高质量的 MR 项目方面仍面临诸多挑战。文献已经确定了系统障碍，包括技术能力和数据互操作性。然而，组织文化作为根本原因尚未得到充分探索。
我们的目标是开发一个实施准备度调查问卷，并衡量整个医疗保健企业的员工对 MR 的态度。
我们使用 Research Electronic Data Capture（REDCap）软件向 170 个退伍军人事务部（VA）站点开发和分发了一份问卷。问卷包含 21 个李克特量表项目，衡量了三个结构，如：（1）临床医生对 MR 的重视程度；（2）对工作流程兼容性的看法；（3）对实施组织氛围的看法。
8704 名临床医生和工作人员对我们的问卷做出了回应（170 个 VA 设施中的 142 个）。大多数员工认为重整药物可以提高药物安全性（约 90%的人认为这是“重要的”）。然而，大多数人（约 90%）也对工作流程的变化表示担忧。三分之一的受访者将其他职责置于 MR 之前，并报告了与实施气候相关的障碍。只有 47%的受访者同意他们有足够的资源来解决发现的差异。
我们的研究结果表明，MR 准备度评估可以预测挑战，并为制定与上下文相关的实施包提供信息。调查的临床医生在资源、技术挑战和实施气候方面存在困难。一个强有力的运动应该包括明确的领导信息、可信的拥护者和资源，以克服技术挑战。
本文提供了一种进行准备度评估的方法，并强调了组织文化在 MR 活动中的重要性。这些数据可以帮助评估 MR 变更管理计划的站点或网络准备情况。
