Barriers in communicating medication changes at hospital discharge: Informing CancelRx design requirements. Issue 3 (June 2021)

• Record Type: Journal Article
• Authors: Yang, Yushi; Pitts, Samantha I; Chen, Allen R
• Is Part Of: Journal of patient safety and risk management. Volume 26:Issue 3(2021)
• Page Start: 99
• Page End: 103
• Publication Date: 2021-06
• Subjects: Medication reconciliation -- human factors -- electronic health record -- communication; Medical jurisprudence -- Great Britain -- Periodicals; Medical personnel -- Malpractice -- Great Britain -- Periodicals; Risk management -- Great Britain -- Periodicals
• DOI: 10.1177/25160435211005928
• Languages: English
• ISSNs: 2516-0435

Abstract

Objectives: This operational study aims to investigate the barriers in communicating medication changes at hospital discharge, and to inform design requirements of the CancelRx functionality to better support the communication. Methods: We conducted seven semi-structured interviews with inpatient prescribers at an urban academic medical center. The interview protocol was framed from a human factors perspective, specifically the work system design approach. We took notes of the interviews and identified the initial themes of system barriers that may impact patient safety. Results: Medication changes need to be communicated to multiple stakeholders. We identified two initial themes of the system barriers: the lack of an information flow that connects all the involved stakeholders, and the difficulties to communicate key pieces of information. We identified three key pieces of information that are difficult to communicate: the discontinuation reasons, the notification urgency, and the duration of changes. Conclusions: While the CancelRx functionality can facilitate the communication (e.g. prescribers no longer need to call pharmacists when a medication is discontinued), enhancements are needed to address the system barriers. We proposed enhanced design requirements of the CancelRx functionality, e.g., to allow users to specify a reason for a medication discontinuation and transmit the reasons to other stakeholders, to indicate the urgency of notification, to specify the duration of a change, and to receive system status feedback .