Medication decision-making for patients with renal insufficiency in inpatient and outpatient care at a US Veterans Affairs Medical Centre: a qualitative, cognitive task analysis
| Autor: | Alan J. Zillich, Julie Diiulio, Nervana Elkhadragy, Karen J Arthur, Alissa L. Russ, Amanda P Ifeachor, Laura G. Militello, Michael W. Weiner, Peter A. Glassman |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Kidney Disease 8.1 Organisation and delivery of services Occupational safety and health 0302 clinical medicine Cognition Outpatients Medication Errors medical education and training health and safety 030212 general & internal medicine Renal Insufficiency Qualitative Research Veterans 030503 health policy & services General Medicine Middle Aged Hospitals Public Health and Health Services Female Medical emergency Patient Safety 0305 other medical science Health and social care services research Adult Hospitals Veterans education Clinical Decision-Making Clinical Sciences nephrology Health Informatics Decision Support Techniques Interviews as Topic 03 medical and health sciences Patient safety Ambulatory care Clinical Research Behavioral and Social Science medicine Humans Veterans Affairs Inpatients Other Medical and Health Sciences business.industry Research medicine.disease United States Problem management Task analysis business Qualitative research |
| Zdroj: | BMJ open, vol 9, iss 5 BMJ Open |
| Popis: | BackgroundMany studies identify factors that contribute to renal prescribing errors, but few examine how healthcare professionals (HCPs) detect and recover from an error or potential patient safety concern. Knowledge of this information could inform advanced error detection systems and decision support tools that help prevent prescribing errors.ObjectiveTo examine the cognitive strategies that HCPs used to recognise and manage medication-related problems for patients with renal insufficiency.DesignHCPs submitted documentation about medication-related incidents. We then conducted cognitive task analysis interviews. Qualitative data were analysed inductively.SettingInpatient and outpatient facilities at a major US Veterans Affairs Medical Centre.ParticipantsPhysicians, nurses and pharmacists who took action to prevent or resolve a renal-drug problem in patients with renal insufficiency.OutcomesEmergent themes from interviews, as related to recognition of renal-drug problems and decision-making processes.ResultsWe interviewed 20 HCPs. Results yielded a descriptive model of the decision-making process, comprised of three main stages: detect, gather information and act. These stages often followed a cyclical path due largely to the gradual decline of patients’ renal function. Most HCPs relied on being vigilant to detect patients’ renal-drug problems rather than relying on systems to detect unanticipated cues. At each stage, HCPs relied on different cognitive cues depending on medication type: for renally eliminated medications, HCPs focused on gathering renal dosing guidelines, while for nephrotoxic medications, HCPs investigated the need for particular medication therapy, and if warranted, safer alternatives.ConclusionsOur model is useful for trainees so they can gain familiarity with managing renal-drug problems. Based on findings, improvements are warranted for three aspects of healthcare systems: (1) supporting the cyclical nature of renal-drug problem management via longitudinal tracking mechanisms, (2) providing tools to alleviate HCPs’ heavy reliance on vigilance and (3) supporting HCPs’ different decision-making needs for renally eliminated versus nephrotoxic medications. |
| Databáze: | OpenAIRE |
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