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. Author manuscript; available in PMC: 2023 Aug 11.
Published in final edited form as: Appl Ergon. 2020 Nov 5;91:103299. doi: 10.1016/j.apergo.2020.103299

Table 2.

Streamlining and coordinating clinical management of medication regimens across care settings.

Sub-theme Barriers Strategies Example Clinical Team Member
Quotes
Complex medication management tasks during transitions - Task ambiguity

- Patient understanding of conflicting information

- Multiple hospitals/ providers

- Frequent medication changes
- Follow-up with PCP

-Coordination between doctors/ use of EHR

- Scheduling follow-up appointments for patient
“I have to explain in detail. And I tell them, ‘The paper that you have from our hospital, that’s the one I’m going to be teaching you on.’ And then sometimes we get into this struggle with patients because they’ll say, ‘Well, I just saw my doctor yesterday or two weeks ago and he put me on medication [for fluid retention],’ which is a fluid pill. ‘He put me on that and now you guys tell me to stop it, so what do I do?’ I’m like, ‘Well, go by the most recent summary, which is what we – what I’m going over is they want you to stop it. But now, however, you need to see your primary care right away.’” (Transitional Nurse)
Discrepancies in medication lists at admission and discharge - Not updating admission med reconciliation with accurate medication

-Copy/pasting medication lists (on admission and at discharge)
- Utilizing patients’ medication list(s)

- Comparing to online data/ EHR

- Pharm techs to aid in reconciling medication lists

- Coordination of tasks
“So our pharmacy technicians right now are assisting with getting appropriate medication lists. So sometimes at the discharge point, the provider realizes that the medication list is wrong, and they're trying to send out the right medication list, and so they want to make sure they have the old and the new to compare and write a good instruction sheet for the patient … Because if you don't tell them what to stop and you just tell them to start, they have some conflicting information. So our technicians help with that and … they'll [also] help to get those medications filled at our outpatient pharmacy for them, and then bring them to the bedside. So they leave with the meds in hand.” (Pharmacist)
Integrating high-risk and complicated medication regimens - Multiple chronic conditions - Coordination of clinical care

- Coordination of medication

- Inclusion of pharmacy in process
“So there are high-risk medications that we as case managers go ‘Wait a minute. We need to make sure everything's onboard with this, that they're getting what they need to be done,’ like the levels done. Are they doing what they're supposed to be doing to make sure that the medication's effective for them? … make sure that they're going to a clinic to get their blood tested.” (Case Manager)