Minimizing Harm From ADEs by Improving Nurse-Physician Communication
Condition: Interdisciplinary Communication; Management, Medication Therapy
Study type: Observational

Summary: 
      The purpose of this research study is to examine the clinical processes of care involved with
      the sharing and communicating of medication management information in the inpatient setting
      between nurses, pharmacists and physicians. The study is unique in that few studies have
      examined communication content and processes in depth and in relation to specific clinical
      care. The study will be conducted in two phases. The first phase involves using three focus
      groups across three sites (a total of nine) each involving between 6-8 individuals to examine
      perceptions regarding role and procedures associated with medication management. The focus
      group discussions will be tape-recorded and analyzed using qualitative methods. The
      information gleaned will assist us in identifying patterns of problems in enhancing the
      sharing of information, to develop better measures for assessing communication as well as
      designing effective interventions to enhance communication.

      In the second phase of the study, 400 2-4 hour time slots will be randomly selected over
      about a 5-week period for nursing staff and 500 events over a 6-week period for physicians to
      conduct ethnographic observations during which specific communication events will be recorded
      and coded. Every effort will be made to minimize interruptions during clinical care. This
      research has not been done in terms of medication management content in the inpatient setting
      (non-ICU).
    

Detailed description: 
      Background:

      Medication management is a complex clinical task. It requires substantial collaboration and
      coordination between physicians, nurses and pharmacists. Addressing ineffective communication
      has been identified by the Institute of Medicine as a high priority. Ineffective
      communication regarding medication management coordination can result in increased medication
      errors, rates of adverse drug events (ADEs), delays in treating adverse drug events and less
      effective treatment. ADEs are frequent in hospitalized patients, ranging from less than 3% to
      over 32%. The purpose of this study was to evaluate communication patterns associated with
      medication management between providers, physicians and pharmacists in the inpatient setting.

      Objectives:

      Specific Aim 1. Assess clinicians' beliefs and concerns regarding the role of communication
      in preventing, detecting and managing ADEs in elderly inpatients (focus groups).

      Specific Aim 2. Evaluate and characterize communication events between VA nurses, physicians
      and pharmacists in an inpatient medicine setting (ethnographic observation).

      Methods:

      Phase 1: Focus Groups Design: The design of this study was qualitative and used focus group
      methodology.

      Settings: Three VA sites that differed in size, location and academic affiliation were
      selected.

      Participants: Three focus groups were conducted at each site (one each of pharmacists, nurses
      and physicians). A total of 19 nurses, 16 pharmacists and 13 doctors participated.

      Phase 2: Observation Design: The design of this study was quantitative and descriptive.
      Settings: Two inpatient units at the VA Salt Lake City Health Care System (medicine and
      telemetry).

      Participants: Twelve residents were selected randomly from each of the 4 medical teams, 19
      nurses were selected randomly from the two in-patient medicine wards, and 8 clinical
      pharmacists (the total number of clinical pharmacists available) agreed to participate.

      Status:

      All data have been collected and initial analyses has been completed.
    

Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        VA Physicians, Nurses, and Pharmacists had worked at least one year in the VA and were
        familiar with the VA's electronic health record, CPRS.
      
Keywords: Interdisciplinary Communication; Safety Management; Management, Medication Therapy; Cooperative Behavior; Drug Therapy Management; Physician Nurse Relationships; Side Effects; Hospital Information Systems; Documentation; Quality Assurance, Health Care