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theses

Rationale. This study was undertaken to assess interrelationships among home health agency (HHA) organizational and nursing structures (registered nurse (RN) workload, number of patient visits per day, RN caseload, medication reconciliation (MR) systems, MR facilitators, MR barriers), patient safety culture, and MR processes in patients transitioning to intermittent skilled nursing care after discharge from the hospital. This is among the first of studies looking at home health care and medication management, which includes MR.
Method. Data analysis of de-identified HHA RN-reported MR practices are reported. Foundations used to explore interrelationships between HHA organizational and nursing structures, patient safety culture dimensions, and MR processes are discussed.
Results. The presence of MR facilitators was significantly related to MR processes in both bivariate and multivariate analyses. One of the four patient safety culture dimensions, overall ratings on quality and patient safety, was significantly and positively related to MR processes in bivariate analyses. High MR facilitator scores in HHAs compared to lower MR facilitator scores was significantly and independently associated with 3.48 higher odds of RNs always completing MR. When the effects of MR facilitators and RN current roles (full-time versus part-time) were controlled for, high levels of positive ratings on patient safety and quality were not independently associated with higher odds of MR completion. In a logistic regression model, MR facilitators, RN current role, and overall rating on quality and patient safety accounted for 20% of the variance in MR processes. Using Hayes mediation analysis, RN caseload, number of patient visits per day, workload, MR system types, and MR facilitators/barriers did not exhibit a significant indirect effect on MR processes through their effects on patient safety culture dimensions (teamwork, work pace and pressure, overall perceptions on patient safety and quality, and overall ratings for patient safety and quality) in HHAs.
Conclusion. HHA managers may wish to focus on placement and maintenance of facilitators and assignment of a full-time RN to patients transferring care from hospitals to home health as this may increase the likelihood of MR processes being done.

ETD_9946

Ph.D.

Includes bibliographical references

doi:10.7282/t3-bqzq-v344

ETD doctoral

The author owns the copyright to this work.