Making sense of the cognitive task of medication reconciliation using a card sorting task
File(s)MakingSenseOfTheCognitiveTask.pdf (643.28 KB)
Published version
Author(s)
Type
Journal Article
Abstract
OBJECTIVE:: To explore cognitive strategies clinicians apply while performing a medication reconciliation task, handling incomplete and conflicting information. BACKGROUND:: Medication reconciliation is a method clinicians apply to find and resolve inconsistencies in patients' medications and medical conditions lists. The cognitive strategies clinicians use during reconciliation are unclear. Controlled lab experiments can explore how clinicians make sense of uncertain, missing, or conflicting information and therefore support the development of a human performance model. We hypothesize that clinicians apply varied cognitive strategies to handle this task and that profession and experience affect these strategies. METHOD:: 130 clinicians participated in a tablet-based experiment conducted in a large American teaching hospital. They were asked to simulate medication reconciliation using a card sorting task (CaST) to organize medication and medical condition lists of a specific clinical case. Later on, they were presented with new information and were asked to add it to their arrangements. We quantitatively and qualitatively analyzed the ways clinicians arranged patient information. RESULTS:: Four distinct cognitive strategies were identified ("Conditions first": n = 76 clinicians, "Medications first": n = 7, "Crossover": n = 17, and "Alternating": n = 10). The strategy clinicians applied was affected by their experience ( p = .02) but not by their profession. At the appearance of new information, clinicians moved medication cards more frequently (75.2 movements vs. 49.6 movements, p < .001), suggesting that they match medications to medical conditions. CONCLUSION:: Clinicians apply various cognitive strategies while reconciling medications and medical conditions. APPLICATION:: Clinical information systems should support multiple cognitive strategies, allowing flexibility in organizing information.
Date Issued
2019-12-01
Date Acceptance
2019-02-13
Citation
Human Factors, 2019, 61 (8), pp.1315-1325
ISSN
0018-7208
Publisher
SAGE Publications
Start Page
1315
End Page
1325
Journal / Book Title
Human Factors
Volume
61
Issue
8
Copyright Statement
© 2019, Human Factors and Ergonomics Society. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30912979
Subjects
card sorting task
cognitive task
health care information systems
medication reconciliation
patient safety
Publication Status
Published online
Coverage Spatial
United States
Date Publish Online
2019-03-26