3113 — Stereotypes and Scripts: Identifying and Understanding the Barriers to Effective Collaboration in Medication Management in the VA

Weir CR (SLC GRECC), Kinney A (Division of Epidemiology, University of Utah), Pepper G (College of Nursing, University of Utah), Nebeker J (SLC GRECC), Drews F (SLC IDEAS), Hoffman J (SLC GRECC), Buffum M (VAMC, San Francisco), Birmingham PM (VAMC, San Francisco)

Objectives:
The objective of this qualitative study was to examine the role of interdisciplinary communication in detecting, preventing and treating adverse drug events, and providing quality medication management in older adults. Effective communication results from accurate mental models of other goals and roles, as well as effective tools for creating common ground or shared perspectives. This study explores these concepts in the context of medication management.

Methods:
Using convenience sampling, physicians, nurses and pharmacists were recruited for nine focus groups according to their disciplines in three geographically diverse VA facilities. Structured questions and a vignette guided discussion on the expectations and beliefs each role had of the other in terms of medication management activities, patient care goals, and scope of responsibility. Discussion focused on how these communication factors contributed to causing, detecting, and managing adverse drug events. Each focus group was audiotaped and transcribed. Each team member coded transcripts independently and included: a social psychologist and nurse, two nurse scientists, one who is expert on medication errors, and a physician and pharmacist, both expert on adverse drug events, and a human factors specialist. Final codes and themes were derived in common discussion using qualitative software.

Results:
Five major topic areas emerged: 1) clear and commonly-held role expectations by discipline for ordering, packaging medications and medication administration; 2) role confusion by discipline about assessing patient compliance, providing patient education, and monitoring side effects; 3) pervasive confusion and concerns about who is responsible for medication reconciliation and accurate transfers between settings; 4) perceptions that common communication tools and methods are barriers to timely and effective communication; and 5) specific issues about CPRS.

Implications:
There was agreement about the roles and responsibilities for some causes of adverse drug events, harm, and medication management activities. However, there were differences in perspectives and concerns about medication reconciliation, patient compliance assessment, and patient education provision.

Impacts:
This study demonstrates gaps in perceptions about the roles of each discipline in regards to medication reconciliation and transfer safety. Confusion also existed regarding role responsibilities for patient education and patient compliance. Patient safety may benefit from further exploration of interdisciplinary communication.