The primary goal of the research was to answer two questions:
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- What are the most effective strategies for the reduction of medication errors during the medication reconciliation process?
- Which health care professionals contribute the most to the homogeneity of medication history records?
Demographics of the Sample Population
The sample population studied in the course of the research includes patients and health professionals at Tisch Hospital, New York City. Since the study design is qualitative and the researcher used questionnaires and interviews as instruments for data collection, it is crucial first to mention the demographic characteristics of the sample population. By using non-random convenience sampling (since it was the most accessible), the researcher ended up with a sample of 20 individuals (five doctors, eight male patients, and seven female patients) to interview and survey during the study.
Within the sample of five physicians, two of them were male, and three of them were female. The cultural characteristics of the study are the following: seven White Americans (one doctor and six patients), five African Americans (two doctors and four patients), three Hispanic patients, and five patients of another ethnic background (Asian and Indian). As to the educational level of study participants, all five doctors reported holding a Medical Degree (two Doctors of Medicine, one Master of Medical Science, and two Masters of Clinical Medicine).
The educational background of the patients enrolled in the study was more diverse: one female patient held a Doctor of Philosophy Degree, three male and one female patient held a degree in Economics, two male patients reported holding a degree in engineering, two female patients were studying at college at the time of the research, three female and three male patients only graduated high school and did not have a professional degree. Among the patients that did not have a degree and only graduated high school, African American and Hispanic ethnicities were the most prevalent, which points to the unequal distribution of educational resources within the community.
The income level of the study participants divided into three distinct categories differentiated by annual earnings. Within the sample population, two patients and five doctors reported a salary between $60,000 and $150,000 per year, which placed them in the upper-middle-class category, five patients reported an annual salary between $32,500 and $60,000 and were placed in the middle-class category, eight patients reported their annual salary below $32,500, which puts them in the lower-middle-class category.
As to the occupational characteristics of the study participants, six participants (including five doctors) worked in the medical profession, three participants reported working in marketing and sales, two members were involved in the sphere of education, three participants worked in the service industry, two participants reported to have their own business, and four participants reported being unemployed at the time of the research. The marital status of the sample population divided equally: ten participants reported to be married or engaged while ten participants were single. Lastly, when asked about their religious identity, fourteen participants identified as Christian, two participants identified as Buddhists, two identified as Muslims, and two identified as atheists.
Descriptive Data Points Interpretation
In surveys, study participants were asked to give honest answers to questions pertaining to the occurrence of medication errors during the process of medication reconciliation as well as the role of healthcare professionals in contributing to the homogeneity of medication history records. The questionnaires focused on two distinct themes that directly referred to the initial research questions. Therefore, in order to provide respondents with options to answer the posed questions, the Likert-type scale was used. This means that respondents had to answer the questions by choosing one option from the scale (Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree). Each question in the survey contained a statement regarding medication errors and medication history records, with which the respondents had to either agree or disagree.
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In order to report the results of the questionnaires more clearly, the table below shows the exact answers respondents gave to the posed questions:
|Question||Strongly disagreed||Disagreed||Neutral||Agreed||Strongly agreed|
|Do you agree with the statement that a medical professional is fully responsible for medication errors?||2 participants (10%)||3 participants (15%)||1 participant (5%)||6 participants (30%)||8 participants (40%)|
|Do you agree with the statement that all medication errors result in harm?||1 participant (5%)||2 participants (10%)||1 participant (5%)||7 participants (35%)||9 participants (45%)|
|Do you agree with the statement that all medication errors result from the inadequate reconciliation of documentation?||1 participant (5%)||2 participants (10%)||1 participant (5%)||6 participants (30%)||10 participants (50%)|
|Do you agree with the statement that a process of reconciliation is essential for avoiding medication errors?||2 participants (10%)||2 participants (10%)||4 participants (20%)||5 participants (25%)||7 participants (35%)|
|Do you agree that patients’ lack of knowledge of their medication can contribute to errors?||3 participants (15%)||6 participants (30%)||5 participants (25%)||2 participants (10%)||4 participants (20%)|
|Do you agree with the statement that nurses’ and physicians’ workflows can hinder the quality of reconciliation?||2 participants (10%)||2 participants (10%)||3 participants (15%)||5 participants (25%)||8 participants (40%)|
|Do you agree that there is a need for a clear identification of responsibilities?||3 participants (15%)||5 participants (25%)||2 participants (10%)||3 participants (15%)||7 participants (35%)|
|Do you agree that standardization could aid in making reconciliation more effective?||1 participant (5%)||2 participants (10%)||3 participants (15%)||7 participants (35%)||7 participants (35%)|
|Do you agree that the main responsibility for documentation reconciliation should be placed on the healthcare provider?||4 participants (20%)||3 participants (15%)||4 participants (20%)||4 participants (20%)||5 participants (25%)|
|Do you agree with the statement that the role of the patient is as important?||5 participants (25%)||4 participants (20%)||5 participants (25%)||3 participants (15%)||3 participants (15%)|
|Do you agree with the statement that health care providers and patients should collaborate on improving the quality of medication documentation and avoiding errors?||3 participants (15%)||3 participants (15%)||3 participants (15%)||4 participants (20%)||7 participants (35%)|
Overall, it can be concluded that the research participants placed emphasis on the role of the health care providers as the ones that should be responsible for the management and completion of documentation reconciliation for avoiding errors in medication prescription. However, previous findings show that patients can also play an important role in preventing errors in medication through being educated about what they are prescribed (Barnsteiner, 2008). The questionnaire showed that the participants saw potential in the clear identification of responsibilities and standardization when it comes to effective documentation reconciliation. Moreover, respondents met the idea of collaboration between patients and health care providers with mixed opinions; however, the majority (11 respondents) agreed that such cooperation was needed for avoiding medication errors.
During the interviews, study participants were not confined to strictly answering the questions they were asked. On the contrary, they had more freedom to give their opinions in an essay format and thus provided answers with sufficient details without any constraints. The results of the interviews with both healthcare providers and patients can be divided into three themes, such as the impact of medication errors, responsibilities of the healthcare provider, and the role of patients. If to present the findings of the interviews with doctors, it is crucial to mention that all five participants indicated that the increased workload limits professional’s effectiveness in documentation management, as evidenced by previous research (Child Welfare Information Gateway, 2016).
Moreover, doctors pointed out that a high percentage of patients lack knowledge about the medication that they are prescribed, which subsequently leads to errors in medication. Health care providers agreed that medication errors and improper documentation reconciliation presented a treat to the well-being of patients (Petronio, Helft, & Child, 2013), so there was a high need for the standardization and clear identification of responsibilities, as well as the active participation and contribution of patients.
Patients, on the other hand, referred to the process of documentation reconciliation as the responsibility of doctors and were hesitant regarding their personal role. A prevailing theme of the interviews was patients admitting to having insufficient knowledge about the prescribed medication (Grossmann, Goolsby, Olsen, & McGinnis, 2012); however, they felt that it was the responsibility of their health care providers to provide education on medication they prescribe to patients. Similar to doctors, patients agreed that medication errors and improper documentation reconciliation were threatening to their well-being, although they did not know how the errors could be eliminated effectively.
The research was limited in two areas: the choice of the sampling technique and the final size of the sample. While non-probability convenience sampling is the most accessible since the researcher could select the most convenient units, results derived from this sampling technique have known generalizability only to the studied sample (Bornstein, Jager, & Putnick, 2013). This means that the initial research questions that were addressed with the help of convenience sampling are limited to the sample itself, which was relatively small. Another disadvantage associated with the choice of convenience sampling is linked to the small percentage of underrepresented sociodemographic subgroups, which results in the lack of sufficient power to determine differences in sociodemographic factors (Mosadeghrad, 2014).
Implications for Future Research
The results of the research showed that there are differences in the way patients and health care providers perceived medication errors and documentation reconciliation. Therefore, future research may focus on the development of an action plan to combine the efforts of health care providers and their patients for eliminating medication errors and reducing the limitations associated with the reconciliation of documentation. For example, an intervention where one group of patients will have to collaborate with their healthcare providers can be designed. Then, the patient outcomes regarding medication prescription can be compared with the outcomes of the second group that did not collaborate with their doctors.
Barnsteiner, J. (2008). Medication reconciliation. In R. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (pp. 386-401). Rockville, MD: Agency for Healthcare Research and Quality.
Bornstein, M., Jager, J., & Putnick, D. (2013). Sampling in developmental science: Situations, shortcomings, solutions, and standards. Developmental Review, 33(4), 357-370.
Child Welfare Information Gateway. (2016). Caseload and workload management.
Grossmann, C., Goolsby, A., Olsen, L., & McGinnis, M. (2012). Engineering a learning healthcare system. Washington, DC: The National Academies Press.
Mosadeghrad, A. (2014). Factors influencing healthcare service quality. International Journal of Health Policy and Management, 3(2), 77-89.
Petronio, S., Helft, P. R., & Child, J. T. (2013). A case of error disclosure: A communication privacy management analysis. Journal of Public Health Research, 2(3), 175-181.