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Sunil Kripalani - One of the best experts on this subject based on the ideXlab platform.
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organisational context of hospitals that participated in a multi site mentored medication reconciliation quality improvement project marquis2 a cross sectional observational study
2019Co-Authors: Deonni P Stolldorf, Jeffrey L Schnipper, Amanda S Mixon, Mary S Dietrich, Sunil KripalaniAbstract:Objectives Medication reconciliation (MedRec) is an important patient safety strategy and is widespread in US hospitals and globally. Nevertheless, high quality MedRec has been difficult to implement. As part of a larger study investigating MedRec interventions, we evaluated and compared organisational contextual factors and team cohesion by hospital characteristics and implementation team members’ profession to better understand the environmental context and its correlates during a multi-site quality improvement (QI) initiative. Design We conducted a cross-sectional observational study using a web survey (contextual factors) and a national hospital database (hospital characteristics). Setting Hospitals participating in the second Multi-Centre Medication Reconciliation Quality Improvement Study (MARQUIS2). Participants Implementation team members of 18 participating MARQUIS2 hospitals. Outcomes Primary outcome: contextual factor ratings (ie, organisational capacity, leadership support, goal alignment, Staff Involvement, patient safety climate and team cohesion). Secondary outcome: differences in contextual factors by hospital characteristics. Results Fifty-five team members from the 18 participating hospitals completed the survey. Ratings of contextual factors differed significantly by domain (p 0.05). Respondents in the pharmacy profession gave lower ratings of leadership support than did those in the nursing or other professions group (p=0.01). Conclusions Hospital size, type and location did not drive differences in contextual factors, suggesting that tailoring MedRec QI implementation to hospital characteristics may not be necessary. Strong team cohesion suggests the use of interdisciplinary teams does not detract from cohesion when conducting mentored QI projects. Organisational leaders should particularly focus on supporting pharmacy services and addressing their concerns during MedRec QI initiatives. Future research should correlate contextual factors with implementation success to inform how best to prepare sites to implement complex QI interventions such as MedRec.
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hospital based medication reconciliation practices a systematic review
2012Co-Authors: Stephanie K Mueller, Sunil Kripalani, Kelly C Sponsler, Jeffrey L SchnipperAbstract:Background Medication discrepancies at care transitions are common and lead to patient harm. Medication reconciliation is a strategy to reduce this risk. Objectives To summarize available evidence on medication reconciliation interventions in the hospital setting and to identify the most effective practices. Data Sources MEDLINE (1966 through February 2012) and a manual search of article bibliographies. Study Selection Twenty-six controlled studies. Data Extraction Data were extracted on study design, setting, participants, inclusion/exclusion criteria, intervention components, timing, comparison group, outcome measures, and results. Data Synthesis Studies were grouped by type of medication reconciliation intervention—pharmacist related, information technology (IT), or other—and were assigned quality ratings using US Preventive Services Task Force criteria. Results Fifteen of 26 studies reported pharmacist-related interventions, 6 evaluated IT interventions, and 5 studied other interventions. Six studies were classified as good quality. The comparison group for all the studies was usual care; no studies compared different types of interventions. Studies consistently demonstrated a reduction in medication discrepancies (17 of 17 studies), potential adverse drug events (5 of 6 studies), and adverse drug events (2 of 2 studies) but showed an inconsistent reduction in postdischarge health care utilization (improvement in 2 of 8 studies). Key aspects of successful interventions included intensive pharmacy Staff Involvement and targeting the intervention to a high-risk patient population. Conclusions Rigorously designed studies comparing different inpatient medication reconciliation practices and their effects on clinical outcomes are scarce. Available evidence supports medication reconciliation interventions that heavily use pharmacy Staff and focus on patients at high risk for adverse events. Higher-quality studies are needed to determine the most effective approaches to inpatient medication reconciliation.
Jeffrey L Schnipper - One of the best experts on this subject based on the ideXlab platform.
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organisational context of hospitals that participated in a multi site mentored medication reconciliation quality improvement project marquis2 a cross sectional observational study
2019Co-Authors: Deonni P Stolldorf, Jeffrey L Schnipper, Amanda S Mixon, Mary S Dietrich, Sunil KripalaniAbstract:Objectives Medication reconciliation (MedRec) is an important patient safety strategy and is widespread in US hospitals and globally. Nevertheless, high quality MedRec has been difficult to implement. As part of a larger study investigating MedRec interventions, we evaluated and compared organisational contextual factors and team cohesion by hospital characteristics and implementation team members’ profession to better understand the environmental context and its correlates during a multi-site quality improvement (QI) initiative. Design We conducted a cross-sectional observational study using a web survey (contextual factors) and a national hospital database (hospital characteristics). Setting Hospitals participating in the second Multi-Centre Medication Reconciliation Quality Improvement Study (MARQUIS2). Participants Implementation team members of 18 participating MARQUIS2 hospitals. Outcomes Primary outcome: contextual factor ratings (ie, organisational capacity, leadership support, goal alignment, Staff Involvement, patient safety climate and team cohesion). Secondary outcome: differences in contextual factors by hospital characteristics. Results Fifty-five team members from the 18 participating hospitals completed the survey. Ratings of contextual factors differed significantly by domain (p 0.05). Respondents in the pharmacy profession gave lower ratings of leadership support than did those in the nursing or other professions group (p=0.01). Conclusions Hospital size, type and location did not drive differences in contextual factors, suggesting that tailoring MedRec QI implementation to hospital characteristics may not be necessary. Strong team cohesion suggests the use of interdisciplinary teams does not detract from cohesion when conducting mentored QI projects. Organisational leaders should particularly focus on supporting pharmacy services and addressing their concerns during MedRec QI initiatives. Future research should correlate contextual factors with implementation success to inform how best to prepare sites to implement complex QI interventions such as MedRec.
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hospital based medication reconciliation practices a systematic review
2012Co-Authors: Stephanie K Mueller, Sunil Kripalani, Kelly C Sponsler, Jeffrey L SchnipperAbstract:Background Medication discrepancies at care transitions are common and lead to patient harm. Medication reconciliation is a strategy to reduce this risk. Objectives To summarize available evidence on medication reconciliation interventions in the hospital setting and to identify the most effective practices. Data Sources MEDLINE (1966 through February 2012) and a manual search of article bibliographies. Study Selection Twenty-six controlled studies. Data Extraction Data were extracted on study design, setting, participants, inclusion/exclusion criteria, intervention components, timing, comparison group, outcome measures, and results. Data Synthesis Studies were grouped by type of medication reconciliation intervention—pharmacist related, information technology (IT), or other—and were assigned quality ratings using US Preventive Services Task Force criteria. Results Fifteen of 26 studies reported pharmacist-related interventions, 6 evaluated IT interventions, and 5 studied other interventions. Six studies were classified as good quality. The comparison group for all the studies was usual care; no studies compared different types of interventions. Studies consistently demonstrated a reduction in medication discrepancies (17 of 17 studies), potential adverse drug events (5 of 6 studies), and adverse drug events (2 of 2 studies) but showed an inconsistent reduction in postdischarge health care utilization (improvement in 2 of 8 studies). Key aspects of successful interventions included intensive pharmacy Staff Involvement and targeting the intervention to a high-risk patient population. Conclusions Rigorously designed studies comparing different inpatient medication reconciliation practices and their effects on clinical outcomes are scarce. Available evidence supports medication reconciliation interventions that heavily use pharmacy Staff and focus on patients at high risk for adverse events. Higher-quality studies are needed to determine the most effective approaches to inpatient medication reconciliation.
Joseph J Fins - One of the best experts on this subject based on the ideXlab platform.
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differential medical and surgical house Staff Involvement in end of life decisions a retrospective chart review
2006Co-Authors: Amy S Kelley, Heather T Gold, Keith W Roach, Joseph J FinsAbstract:To quantify the house officer's role in end-of-life decisions, the authors abstracted charts for documentation of end-of-life discussions for 100 patients withdrawn from life-sustaining treatment. They assessed the proportion of end-of-life care notes written by house officers, controlling for service, length of stay, outpatient physician Involvement, race, and diagnostic category. Patients on the medical service were 22 times more likely to have house officer end-of-life notes than patients on the surgical service (P < 0.00001). Sixty-one percent of medical patients and 10% of surgical patients had a do-not-resuscitate note written by a house officer (P < 0.00001). House officers on the medical service wrote a significantly greater proportion of notes regarding withdrawal of care than surgical house officers (41% vs. 10%, P < 0.00001). This study reveals extensive Involvement of medical house officers in primary end-of-life discussions with a complex patient population undergoing withdrawal of life-sustaining therapy. Team structure and professional culture may account for some of the observed differences between the medical and surgical services. These findings have significant implications for the education of house officers on end-of-life communication.
Felix Maringe - One of the best experts on this subject based on the ideXlab platform.
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Staff Involvement in leadership decision making in the uk further education sector perceptions of quality and social justice
2012Co-Authors: Felix MaringeAbstract:Purpose – The purpose of the paper is to explore the quality of leadership decision making at various leadership levels in the further education (FE) sector. Using Hoffberg and Korver's model for integrated decision making, the paper aims to examine how Staff in five UK FE colleges perceive the quality of their Involvement in decision‐making teams and groups and the extent to which decision‐making processes meet Tatum et al.'s criteria for fair and just organisational decision makingDesign/methodology/approach – The paper utilises data from the Integrating Diversity in Leadership Project sponsored by the Centre for Excellence in Leadership. It draws on responses made by 67 Staff in five FE colleges in the UK to a series of qualitative questions in individual interviews. The paper also draws on observations of the level and quality of interaction and contribution made by 147 Staff in 15 leadership decision‐making groups. The paper only draws on those responses that have relevance to the questions of leader...
Charlotte Jonasson - One of the best experts on this subject based on the ideXlab platform.
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academic Staff Involvement and openness to diversity in international educational organisations is there a moderating effect of shared language
2013Co-Authors: Jan Selmer, Jakob Lauring, Charlotte JonassonAbstract:Joint work among academic Staff is important for solving the ever-increasing number of complex tasks that are becoming part of everyday activities in higher education. At the same time, diversification and internationalisation may challenge collaboration processes and communication demands. Speaking a shared language consistently could be a way of overcoming problems. Hence, this study focuses on the effect of shared language among academic Staff on the relation between academic Staff Involvement in work processes and openness to diversity. This study draws on data from 489 Danish academic Staff members in science departments of three universities. Results show positive associations between academic Staff Involvement and all openness-to-diversity variables (openness to informational, linguistic, value and visible diversity). Shared language had a positive effect on openness to surface level types of diversity (linguistic and visible) but no effect on openness to deep-level types of diversity (informational and value).