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Table 2 Summary of themes describing barriers and driver to medicines reconciliation

From: Barriers and facilitators of medicines reconciliation at transitions of care in Ireland – a qualitative study

 BarriersFacilitators
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
  1. HCP Healthcare Professional, ICT Information Communication Technology, FTE Full Time Equivalent, NCHD Non-consultant Hospital Doctor, HP Hospital Pharmacist