Clinical trial NCT00574990: Minimizing Harm From ADEs by Improving Nurse-Physician Communication
Official title: Minimizing Harm From ADEs by Improving Nurse-Physician Communication
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Interdisciplinary Communication
Management, Medication Therapy
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
Lead sponsor: VA Office of Research and Development
Sponsor class: FED
First posted: 2007-12-17
Enrollment: 39
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
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.

Brief 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.

Eligibility criteria: Inclusion Criteria:

Providers who are working in the VA on the inpatient setting, including pharmacists, nurses, and physicians.

Exclusion Criteria:

Staff who have worked at the VA less than 1 year.

Primary outcomes:
measure: Incident Rate for Communication Events
timeFrame: 6 months
Secondary outcomes:
measure: Overall Involvement in Conversation by Roles
timeFrame: 6 months
Other outcomes:
Locations:
city: San Francisco
country: United States
facility: VA Medical Center, San Francisco
state: California
city: Asheville
country: United States
facility: VA Medical Center, Asheville
state: North Carolina
city: Salt Lake City
country: United States
facility: Salt Lake City
state: Utah
Study officials:
affiliation: Salt Lake City
name: Charlene R Weir, PhD RN
role: PRINCIPAL_INVESTIGATOR
References:
citation: Flaherty JH, Shay K, Weir C, Kamholz B, Boockvar KS, Shaughnessy M, Shapiro R, Gordon S, Stein J, Rudolph JL; VA Delirium Working Group. The development of a mental status vital sign for use across the spectrum of care. J Am Med Dir Assoc. 2009 Jul;10(6):379-80. doi: 10.1016/j.jamda.2009.04.001. No abstract available.
citation: Vogelsmeier A, Pepper GA, Oderda L, Weir C. Medication reconciliation: A qualitative analysis of clinicians' perceptions. Res Social Adm Pharm. 2013 Jul-Aug;9(4):419-30. doi: 10.1016/j.sapharm.2012.08.002. Epub 2012 Oct 23.