Table 3.

Summary of Barriers That Hindered Coordination of Care When Responding to Medication Safety Incidents

Barrier	Definition	Examples
EHR-related challenges	Hindrances associated with EHR design and use, including trust in electronic tools, relying on them as a primary or sole source for communication about incidents, and obstacles related to asynchronous electronic communication.	“[Electronic communication is] typically what I do when I contact PCPs. It’s hard to reach them by phone. In my experience, they don’t answer their pagers always, but it’s easy to type a little addendum to the [EHR] note. If there were a better way, maybe I could just go up to her directly and it would’ve shaved two days off of resolving this [drug interaction concern].”—physician #3
Breakdowns in care	Gaps in care due to delays in receiving information or executing actions, mishaps, misinformation, incomplete handoffs and usual care processes that were unaddressed or only partially completed.	“Here’s a patient having a reaction to a medication I’d prescribed and nobody has made me aware of it!”—physician #4
Role ambiguity and constraints	Problems or confusion arising from unclear responsibilities, medication-related authority, and ownership of patient care activities, including who should make medication-related decisions or execute actions.	“…why the heck did not [the PCP] just make the executive decision? It’s her patient, too, [and] there’s no reason [for the patient] to be on an alpha-blocker [doxazosin]….I was actually really frustrated that the provider just didn’t stop it…”—pharmacist #3
Complexity	Organizational, team, and patient factors that made it more complicated for healthcare professionals to coordinate care when addressing medication incidents.	“I don’t know who all the [clinical] pharmacists are that serve all the different clinics. A lot of them wear a couple different hats…. there’s no central reference …. [and it’s unclear] how best to contact them and how long it takes [for them to reply].”—physician #2

EHR, electronic health record; PCP, primary care physician