Table 2 Perceived barriers and drivers to the implementation of medication reconciliation
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 | Â | 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 |
| Â | Â | Involve all professionals, including community caregivers |
 Patients  |  |  |
Knowledge | Limited knowledge of their medications | Encourage patient empowerment through education |
Awareness | Â | Increase the awareness and responsibility for, carrying an up-to-date medication list |
Attitude | Patient has other needs or priorities | Â |
 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 |
| Â | 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 |
| Â | Â | Good and clear leadership |
Competition | Â | 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 |
| Â | Investing time, effort and resources | |
| Â | Â | Having a detailed implementation plan |
| Â | Â | Clear and uniform forms and protocols |
Chain of care | Medication reconciliation not being implemented at every transfer or in related departments | Â |
Task reallocation | No agreements regarding tasks and responsibilities | Clear descriptions of roles, tasks and responsibilities |
| Â | Â | 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 |
| Â | Â | A central incident reporting system for both hospital and community caregivers |
Feasibility | Simultaneous implementation of multiple safety interventions | |
ICT | Â | Digital support for implementation, measurement and feedback of quality indicators |
| Â | Â | 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 |
| Â | Undersigning the discharge medication list implies a legal | Reinforcement by the Health Care Inspectorate |
| Â | responsibility for all prescribed medication | Â |