⚡ Language Barriers In Implementing Transitions Of Care
Some factors had both positive and negative effects on Language Barriers In Implementing Transitions Of Care, particularly in the domains of intervention process, inner setting, and outer setting Table 5. We must provide victims with the Language Barriers In Implementing Transitions Of Care care, treatment and attention for uranus-god human race will not Assignment: Nurse Family Partnership if we ignore a large portion of population. Communication with parents and patients was also a challenge, street corner society given the framing of HPV vaccine as a choice rather than a requirement. Staff buy-in 5 FQHCs. If an in-person interpreter is required Language Barriers In Implementing Transitions Of Care running late, Personal Narrative: My Experience Of Racism an audio or video interpreter to inform the patient of what is going Language Barriers In Implementing Transitions Of Care. Qualitative research: Language Barriers In Implementing Transitions Of Care methods in health care settings. Int J Qual Heal Care.
UC Davis nursing students reducing language barriers to improve health care
The last step in EBP is to evaluate the outcomes and disseminate the results. On paper, this flows in an orderly fashion. We often face barriers that can make it hard to change, but strategies exist to help facilitate practice change. Time and knowledge: When asked what they need more of, busy clinicians will often say time is their priority. Lack of time is often cited as a barrier to implementing EBP. In addition, uncertainty or lack of knowledge about the EBP process is also a barrier, which includes critiquing and appraising the literature related to the clinical problem being addressed. Changing this culture can be a challenge, but as EBP becomes the norm in health care, it should be easier to overcome. Semi-structured interviews were conducted in Ireland with a wide range of healthcare professionals HCPs involved with medicines reconciliation at transitions of care.
Thematic analysis was undertaken using an adaptation of a combined theoretical framework of Grol, Cabana and Sluisveld to classify the barriers and facilitators to implementation of medicines reconciliation. Thirty-five participants were interviewed, including eleven community pharmacists CPs , eight hospital pharmacists HPs , nine hospital consultants HCs , five general practitioners GPs , and two non-consultant hospital doctors NCHDs. Themes were categorized into barriers and facilitators. Barriers included resistance from existing professional cultures, staff interest and training, poor communication and minimal information and communications technology ICT support.
Solutions facilitators suggested included supporting effective multidisciplinary teams, greater involvement of pharmacists in medicines reconciliation, ICT solutions linked prescribing databases, decision support systems and increased funding to provide additional e. Medicines reconciliation is advocated as a solution to the known problem of medication error at transitions of care. This study identifies the key challenges and potential solutions that policy makers, managers and HCPs should consider when reviewing the practices and processes of medicines reconciliation in their own organisations.
Peer Review reports. Medication reconciliation is recommended by many patient safety and regulatory organisations as a process to reduce these errors [ 1 , 2 , 3 ]. While regulatory organisations may require reconciliation, they are not specific in the mechanism required to undertake this. Indeed, a failure to agree practically useful outcomes, an ambiguity in intervention requirements and an unpreparedness for local circumstances suggest the need for an implementation science review of current practice [ 5 , 6 ].
Many differing examples of implementation theories for healthcare interventions have previously been published [ 7 ]. The theories attempt to describe the complex and multiple influences on the success or failure in adopting a new process. These influences include the innovation itself, the receptiveness of actors within the system, organisational or system adoption of the innovation, networks of dissemination, and extra-organisational issues e. A number of previous studies have examined the experience of healthcare professionals HCPs including physicians, nurses, pharmacists and hospital administrators in managing medicines at transitions of care [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ].
However, a systematic understanding of the factors that influence implementation of medicines reconciliation in Ireland is lacking. The aim of this study was to explore the barriers and facilitators with healthcare professionals to the implementation of medicines reconciliation both between and within primary and secondary care in Ireland. A qualitative study was undertaken, with data being collected via face-to-face semi-structured interviews. The first author PR , a practising male GP, was a PhD student in Health Services Research interacting regularly with healthcare providers including some of the participants involved in this study.
The research team with backgrounds in pharmacy and health services research identified the initial participants as per the sampling strategy see below , with some participants known to the research team in advance and some suggested by participants during the study period. Beyond declaring an interest in the area of medication reconciliation, neither personal goals nor future research agendas were discussed with participants by the interview team. The theoretical framework used, as shown in Fig. Barriers and drivers to the implementation of medicines reconciliation. Adapted from Sluisveld, [ 13 ]. Hospital consultants HC may practise in private and publicly funded institutions. Community pharmacists CPs and general practitioners GPs are private contractors who provide care to patients who are publicly funded as well as self-paying.
Many different HCPs are involved in coordinating the care of patients both within and between primary and secondary care e. There is little interoperability within or between primary and secondary care systems. No institution provides comprehensive electronic prescribing. The majority of prescribing is done by doctors; prescriptions initiated in secondary care are often transcribed for longterm use by GPs in primary care. Medication errors at care transitions continue to be common [ 17 , 18 , 19 ].
The target population was doctors and pharmacists directly involved with medicines reconciliation between primary and secondary care in Ireland. Purposive sampling was used to ensure maximum variation in terms of clinical commitment, geographic region, profession etc. The number of interviews depended on reaching thematic saturation across the group, which was determined by diminishing returns in concurrent data analysis [ 20 , 21 ]. Data were collected between July and December The interview guide was devised based on existing literature, the theoretical framework Fig.
All HCPs were interviewed alone. The interview questions consisted of closed, open-ended and probing questions e. Field notes may have been taken by the interviewer. While these were not the basis for analysis, interviewers were debriefed PR after each interview with field notes, where available, to identify additional potential areas of exploration, and focus for subsequent interviews. Voice recordings were transcribed verbatim, with any identifying information removed. The transcription was checked against the original recording for accuracy. A process of line-by-line deductive coding was undertaken. Research team members compared codes within and across interviews to elucidate themes.
Where data represented more than one theme, dual coding was undertaken. Where novel themes were uncovered that could not be placed within the existing framework, new codes were developed. One consented HCP was uncontactable for the duration of the study. It was not necessary to create additional main themes. The main points for each theme are summarised in Table 2 , categorised under barriers and facilitators. This theme addressed the complexity, feasibility and usefulness of the intervention.
Implementing medicines reconciliation was described by most contributors as a complex process. The complexity of the reconciliation intervention and broader but related healthcare system issues e. This was highlighted in responses that listed the number of HCPs and sources e. GP, carer, community pharmacy that need to be consulted to conduct a comprehensive medicines reconciliation:. So, you have invariably got the patient and their wider carers and family etc. The established communication pathways between HCPs, and their failings, were underlined as barriers:. The facilitators in implementing medicines reconciliation included tailoring the process to locally available resources:. We put a huge resource into nursing.
This theme encompasses issues of attitudes, motivation to change, knowledge and education. Indeed, staff training, across different disciplines and with the transient nature of some staff e. NCHDs , was recognised as important but challenging to implement:. Low HCP interest in, and limited attention to, reconciliation and medicines management was a reported barrier:. Overlapping with social and organisational themes, respondents highlighted the institutional responsibility to increase the medicines reconciliation profile as a patient safety issue and to garner patient interest:. This theme related to issues experienced by, or with direct input from, patients e. Many responses in this theme were an interplay between the patient input and the organisational provisions for patients e.
One respondent felt the medicines administration process in their hospital led to difficulties for staff in empowering patients to take control of managing their own medicines following discharge:. Targeting those patients more at risk of medication error, through morbidity or medicines burden, was deemed important, for example, cognitive decline and associated capacity issues relating to medicines management. Suggested strategies included involving family members in medicines management, and risk stratification on admission to hospital, or use of technology aids.
The difficulty in building effective multidisciplinary teams, a proposed solution, was discussed. Different training, staff hierarchies or beliefs around healthcare delivery were seen as entrenched, especially between doctors and other HCPs:. The lack of interdisciplinary communication in primary care in clarifying medication regimens was raised by many contributors:.
Leading by example and social learning, for example involving all staff in the medicines reconciliation challenge, were listed as good practices: [ 24 ]. Frustration with ICT issues was frequently reported. Numerous examples were presented including incompatibility of handwritten and electronic systems, inaccurate electronic records, and lack of interoperability or coordination between and within settings. There was a perceived lack of a coordinated national strategy to utilise electronic solutions to improve medicines management:. Many respondents discussed the creation of new roles or the shifting of tasks from the traditional providers e. ICT was seen, by many, as a major component of an effective reconciliation programme. A linked accessible dispensing database was described by one contributor:.
This theme covered political, legal and regulatory issues. The barriers to reconciliation listed here presented conflicting views from respondents. Furthermore, programs that train the health care team to be more culturally competent—skilled at understanding, communicating with, and providing high-quality care to patients of diverse backgrounds—are also critical. What are the key steps they need to take to assure care transitions and an effective discharge process for all patients, including those who experience language barriers? Project RED, created by a research group at Boston University Medical Center, in Boston, USA, develops and tests strategies to improve the hospital discharge process in a way that promotes patient safety and reduces re-hospitalization rates.
Project RED was adapted with a particular focus on meeting the needs of diverse populations, and provides three major recommendations, as well as strategies to implement them. The three major recommendations are: 1 hiring bilingual, bicultural discharge educators; 2 providing cultural and linguistic competence training; and 3 ensuring availability of interpreter and translation services. It represents the culmination of a two-year, comprehensive research project funded by AHRQ focused on how to better identify and prevent medical errors in patients who experience language barriers. The Guide identifies certain high-risk clinical scenarios where language barriers can significantly compromise care. These include medication reconciliation, informed consent, emergency department care, surgical care, and most relevant to this discussion—patient discharge.
This includes, for example, guidance on how to incorporate the interpreter as part of team-based care during a high-risk scenario such as patient discharge. These are but just two guides that provide practical, actionable strategies to improve communication and care of patients with language barriers during such critical situations such as patient discharge. In summary, the article by Rayan et al. If we are to truly deliver high-quality, safe, cost-effective care, meeting the needs of patients who experience language barriers during health care will be essential, as global migration and diversity increase every day. Rayan N, Admi H, Shadmi E: Transitions from hospital to community care: the role of patient—provider language concordance.
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