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Table 2 Perceived barriers and drivers to the implementation of medication reconciliation

From: Medication reconciliation at hospital admission and discharge: insufficient knowledge, unclear task reallocation and lack of collaboration as major barriers to medication safety

Levels Perceived Barriers Perceived Drivers
 Innovation    
Usefulness The bundle does not meet the wishes or needs of professionals Bundle creates more clarity about medication
Complexity Complex process, many professionals involved Clear written manual and protocol of bundle
Compatibility   Tailoring bundle to individual departments or specialities
Credibility Lack of evidence of the effectiveness of the bundle
 Professionals    
Knowledge Insufficient knowledge of the health care problem, the bundle,
benefits of innovation, best performance and generating feedback
Not convinced that innovation leads to better and more efficient care
Cognition Do not recognize the care problem
Physicians prefer to conduct medication reconciliation themselves
Awareness Resistance to the imposed way of working Creating awareness of the health care problem by process mapping
Attitude Shifting responsibilities Quality and safety are seen as important
   Involve all professionals, including community caregivers
 Patients    
Knowledge Limited knowledge of their medications Encourage patient empowerment through education
Awareness   Increase the awareness and responsibility for, carrying an up-to-date medication list
Attitude Patient has other needs or priorities  
 Social context    
Social learning Top down implementation results in less involvement of departments and professionals Snowball effect of best practice
Collaboration No collaboration or arrangements between departments and hospital and community caregivers Having a multidisciplinary project group in charge of the implementation
  Information from community pharmacies is not available during out of office hours Regional collaboration and agreements
Leadership No sanction for departments who do not implement the bundle The reinforcement and support of the bundle by management
   Good and clear leadership
Competition   Competitive spirit between departments
 Organisation    
Implementation resources Extra resources not being available for adhering to the bundle and to measure indicators Adopting a phased approach to implementation
  Investing time, effort and resources
   Having a detailed implementation plan
   Clear and uniform forms and protocols
Chain of care Medication reconciliation not being implemented at every transfer or in related departments  
Task reallocation No agreements regarding tasks and responsibilities Clear descriptions of roles, tasks and responsibilities
   Task reallocation to and more involvement of pharmacy technicians
Staff High turnover of personnel and interns Protocol for new personnel
Feedback Quality indicators are not measured, no feedback information available Create an evaluation and feedback mechanism
   A central incident reporting system for both hospital and community caregivers
Feasibility Simultaneous implementation of multiple safety interventions
ICT   Digital support for implementation, measurement and feedback of quality indicators
   Regional or national electronic medication patient file
 Economic, political and legal context 
Economic Market forces result in competition for tasks and funding among care professionals
Political Social pressure to save money Patient safety is an important political subject
Legal Uncertainty about patient privacy Obligation by government
  Undersigning the discharge medication list implies a legal Reinforcement by the Health Care Inspectorate
  responsibility for all prescribed medication