Interdisciplinary Communication Clinical Trial
Official title:
Minimizing Harm From ADEs by Improving Nurse-Physician Communication
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).
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
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