Using Timeline Displays to Improve Medication Reconciliation

Abstract --Objective: To explore approaches for integrating and visualizing time-oriented medication data in narrative and structured formats and to address related issues on handling temporal abstraction, granularity, and uncertainty. The ultimate goal is to improve medication reconciliation by providing clinicians with more accurate medication information in patient care. Methods: An event taxonomy was generated to capture different combinations of clinical and temporal uncertainties. A prototype of a temporal visualization system was implemented using an open source software package called Timeline. Medications were parsed and mapped to the event taxonomy, and then represented in Timelines. Seventy-five medications from narrative discharge summary reports and seventy-nine medications from structured orders were used as data input for temporal visualization. Five physicians served as domain experts and answered ten proof-of-concept survey questions. Results: Overall positive feedback from experts suggested the potential value of the proposed timeline visualization method. Challenges were also identified, and future work will include reconciliation of medications from various sources based on temporal attributes and medication classification

Medicines Reconciliation: Roles and Process. An examination of the medicines reconciliation process and the involvement of patients and healthcare professionals across a regional healthcare economy, within the United Kingdom.

Medication safety and improving communication at care transitions are an international priority. There is vast evidence on the scale of error associated with medicines reconciliation and some evidence of successful interventions to improve reconciliation. However, there is insufficient evidence on the factors that contribute towards medication error at transitions, or the roles of those involved. This thesis examined current UK medicines reconciliation practice within primary and secondary care, and the role of HCPs and patients. Using a mixed-method, multi-centre design, the type and severity of discrepancies at admission to hospital were established and staff undertaking medicines reconciliation across secondary and primary care were observed, using evidence-informed framework, based on a narrative literature review. The overall processes used to reconcile medicines were similar; however, there was considerable inter and intra-organisational variation within primary and secondary care practice. Patients were not routinely involved in discussions about their medication, despite their capacity to do so. Various human factors in reconciliation-related errors were apparent; predominantly inadequate communication, individual factors e.g. variation in approach by HCP, and patient factors e.g. lack of capacity. Areas of good practice which could reduce medicines reconciliation-related errors/discrepancies were identified. There is a need for increased consistency and standardisation of medicines reconciliationrelated policy, procedures and documentation, alongside communication optimisation. This could be achieved through a standardised definition and taxonomy of error, the development of a medicines reconciliation quality assessment framework, increased undergraduate and post-graduate education, improved patient engagement, better utilisation of information technology and improved safety culture