Table 2 Summary of themes describing barriers and driver to medicines reconciliation
Barriers | Facilitators | |
|---|---|---|
Innovation | • Complex - many different healthcare providers • Poor existing communication pathways | • Tailoring processes to local needs • Standard operating procedures and staff adoption of same |
Healthcare Professionals | • Staff training and supervision • Existing culture and hierarchies • Interest and awareness of reconciliation • Unclear lines of responsibility • Time pressures and prioritization | • Institutional effort to boost profile of reconciliation • Teaching prescribing • Culture change |
Patients | • Lack of health literacy • Responsibility of prescribing information – patient vs HCP • HCP commitment to patient education | • Empowering patients • Risk stratifying/targeting those most at risk • Involving patient supports e.g. family members, ICT, multi-compartment compliance aids |
Social context | • Multiple prescribers not communicating • Lack of effective multidisciplinary care (not supporting new roles, not sharing information) | • Clear, effective, systematic lines of communication • Teamwork culture • Local leaders, social learning and disseminating good practice |
Organisation | • Lack of a coordinated ICT strategy • Fallible paper-based systems • System not robust enough to accommodate different patient presentations e.g. elective vs non-elective • Service availability not reflecting need • Lack of funding/remuneration to expand activities • Training, supervision, capacity of NCHDs all limited • HPs absent from hospital discharge • Clinical and prescribing information not intrinsically linked | • Funding to increase staff/service capability e.g. 8 am-8 pm, more FTEs • ICT solutions – linked prescribing databases, decision support systems • Greater involvement of pharmacists e.g. pharmacist prescribing, medicines use reviews |
Political, legal and economic | • Ambiguity around official ‘MedRec’ policy • Disconnect between policy and practice • Discrepancy between private and publicly funded patients • Contractual/remuneration concerns • Data protection concerns | • Positive steps by health authority appointing health informatics lead • Putting in place systems to support good prescribing practice • Feedback on good/bad practice |