Abstract
Objectives
Characterize the work that home health care (HHC) admission nurses complete as part
of the medication reconciliation tasks, explore the impact of shared electronic medication
data (interoperability) from the referral source on medication reconciliation, and
highlight opportunities to enhance medication reconciliation with respect to transition
in care to HHC agencies.
Design
Observational field study.
Settings and Participants
Three diverse Pennsylvania HHC agencies; each used different electronic health record
systems with different interoperability characteristics. Six nurses per site admitted
2 patients each (36 patients total).
Methods
Researchers observed the admission process in the patient home and at the HHC agency.
The nurses’ tasks related to medication reconciliation were characterized by (1) number
and change types (ie, medications dropped or added; changes to dose, frequency/administration
time, or tablet types) made to the referrer medication list during and after the home
visit, and (2) reasons that the nurse called the health provider (doctor, pharmacy)
to resolve medication-related issues. Differences between interoperable and non-interoperable
observations were explored.
Results
Polypharmacy (on average, study patients were taking more than 12 medications) and
high-risk medications (on average, more than 8 per patient) were pervasive. For 91%
of patients, the number of medications decreased between pre- and post-reconciliation
medication lists; 41% of the medications required changes. Nurses using interoperable
systems needed to make fewer changes than nurses using non-interoperable systems.
In two-thirds of observations, the nurse called a provider.
Conclusions and Implications
Changes to the referrer medication list and calls to providers highlighted the nurses’
effort to complete the medication reconciliation. Interoperability appeared to reduce
the number of changes required, but did not eliminate changes or calls to providers.
We highlight opportunities to enhance medication reconciliation with respect to transition
in care to HHC agencies.
Keywords
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Article info
Publication history
Published online: July 25, 2020
Footnotes
This work was supported by the Agency for Healthcare Research and Quality (Grant R01 HS024537), “Information Needs of Homecare Nurses During Admission and Care Planning.” The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
